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Patrick RE, Dickinson RA, Gentry MT, Kim JU, Oberlin LE, Park S, Principe JL, Teixeira AL, Weisenbach SL. Treatment resistant late-life depression: A narrative review of psychosocial risk factors, non-pharmacological interventions, and the role of clinical phenotyping. J Affect Disord 2024; 356:145-154. [PMID: 38593940 DOI: 10.1016/j.jad.2024.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 03/30/2024] [Accepted: 04/03/2024] [Indexed: 04/11/2024]
Abstract
BACKGROUND Treatment resistant depression (TRD) is a subset of major depressive disorder (MDD) in which symptoms do not respond to front line therapies. In older adults, the assessment and treatment of TRD is complicated by psychosocial risk factors unique to this population, as well as a relative paucity of research. METHODS Narrative review aimed at (1) defining TRLLD for clinical practice and research; (2) describing psychosocial risk factors; (3) reviewing psychological and non-pharmacological treatments; (4) discussing the role of clinical phenotyping for personalized treatment; and (5) outlining research priorities. RESULTS Our definition of TRLLD centers on response to medication and neuromodulation in primary depressive disorders. Psychosocial risk factors include trauma and early life adversity, chronic physical illness, social isolation, personality, and barriers to care. Promising non-pharmacological treatments include cognitive training, psychotherapy, and lifestyle interventions. The utility of clinical phenotyping is highlighted by studies examining the impact of comorbidities, symptom dimensions (e.g., apathy), and structural/functional brain changes. LIMITATIONS There is a relative paucity of TRLLD research. This limits the scope of empirical data from which to derive reliable patterns and complicates efforts to evaluate the literature quantitatively. CONCLUSIONS TRLLD is a complex disorder that demands further investigation given our aging population. While this review highlights the promising breadth of TRLLD research to date, more research is needed to help elucidate, for example, the optimal timing for implementing risk mitigation strategies, the value of collaborative care approaches, specific treatment components associated with more robust response, and phenotyping to help inform treatment decisions.
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Affiliation(s)
- Regan E Patrick
- Department of Neuropsychology, McLean Hospital, Belmont, MA, United States of America; Division of Geriatric Psychiatry, McLean Hospital, Belmont, MA, United States of America; Department of Psychiatry, Harvard Medical School, Boston, MA, United States of America.
| | - Rebecca A Dickinson
- Department of Neuropsychology, McLean Hospital, Belmont, MA, United States of America; Division of Geriatric Psychiatry, McLean Hospital, Belmont, MA, United States of America
| | - Melanie T Gentry
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States of America
| | - Joseph U Kim
- Department of Neurology, Brigham and Women's Hospital, Boston, MA, United States of America
| | - Lauren E Oberlin
- Department of Psychiatry, Weill Cornell Medicine, New York, NY, United States of America; AdventHealth Research Institute, Neuroscience, Orlando, FL, United States of America
| | - Soohyun Park
- Department of Psychiatry, Tufts Medical Center, Boston, MA, United States of America
| | - Jessica L Principe
- Division of Geriatric Psychiatry, McLean Hospital, Belmont, MA, United States of America; Department of Psychiatry, Harvard Medical School, Boston, MA, United States of America; Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States of America; Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, United States of America
| | - Antonio L Teixeira
- Department of Psychiatry & Behavioral Sciences, UT Health Houston, Houston, TX, United States of America
| | - Sara L Weisenbach
- Department of Neuropsychology, McLean Hospital, Belmont, MA, United States of America; Division of Geriatric Psychiatry, McLean Hospital, Belmont, MA, United States of America; Department of Psychiatry, Harvard Medical School, Boston, MA, United States of America
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Attarha M, Mahncke H, Merzenich M. The Real-World Usability, Feasibility, and Performance Distributions of Deploying a Digital Toolbox of Computerized Assessments to Remotely Evaluate Brain Health: Development and Usability Study. JMIR Form Res 2024; 8:e53623. [PMID: 38739916 PMCID: PMC11130778 DOI: 10.2196/53623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 03/15/2024] [Accepted: 04/11/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND An ongoing global challenge is managing brain health and understanding how performance changes across the lifespan. OBJECTIVE We developed and deployed a set of self-administrable, computerized assessments designed to measure key indexes of brain health across the visual and auditory sensory modalities. In this pilot study, we evaluated the usability, feasibility, and performance distributions of the assessments in a home-based, real-world setting without supervision. METHODS Potential participants were untrained users who self-registered on an existing brain training app called BrainHQ. Participants were contacted via a recruitment email and registered remotely to complete a demographics questionnaire and 29 unique assessments on their personal devices. We examined participant engagement, descriptive and psychometric properties of the assessments, associations between performance and self-reported demographic variables, cognitive profiles, and factor loadings. RESULTS Of the 365,782 potential participants contacted via a recruitment email, 414 (0.11%) registered, of whom 367 (88.6%) completed at least one assessment and 104 (25.1%) completed all 29 assessments. Registered participants were, on average, aged 63.6 (SD 14.8; range 13-107) years, mostly female (265/414, 64%), educated (329/414, 79.5% with a degree), and White (349/414, 84.3% White and 48/414, 11.6% people of color). A total of 72% (21/29) of the assessments showed no ceiling or floor effects or had easily modifiable score bounds to eliminate these effects. When correlating performance with self-reported demographic variables, 72% (21/29) of the assessments were sensitive to age, 72% (21/29) of the assessments were insensitive to gender, 93% (27/29) of the assessments were insensitive to race and ethnicity, and 93% (27/29) of the assessments were insensitive to education-based differences. Assessments were brief, with a mean duration of 3 (SD 1.0) minutes per task. The pattern of performance across the assessments revealed distinctive cognitive profiles and loaded onto 4 independent factors. CONCLUSIONS The assessments were both usable and feasible and warrant a full normative study. A digital toolbox of scalable and self-administrable assessments that can evaluate brain health at a glance (and longitudinally) may lead to novel future applications across clinical trials, diagnostics, and performance optimization.
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Woolf C, Kaplan L, Norrie LM, Burke D, Cunich M, Mowszowski L, Naismith SL. A feasibility, randomised controlled trial of Club Connect: a group-based healthy brain ageing cognitive training program for older adults with major depression within an older people's mental health service. BMC Psychiatry 2024; 24:208. [PMID: 38500095 PMCID: PMC10946102 DOI: 10.1186/s12888-023-05391-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 11/21/2023] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND Using the RE-AIM (reach, effectiveness, adoption, implementation, maintenance) framework, we outline steps taken to implement an evidence-based cognitive training program, Club Connect, in older adults with major depressive disorder in an Older People's Mental Health Service in Sydney, Australia. The primary aim was to explore feasibility (or 'reach'), tolerability (or 'implementation'), and acceptability (or 'adoption'). The secondary aim was to explore the most sensitive clinical outcomes and measurement tools (i.e. 'effectiveness') to inform a formal randomised controlled trial, and to explore the healthcare resources used (i.e. costs) to assist decision-making by health care managers and policy-makers in relation to future resource allocation. METHODS Using a single blinded feasibility design, 40 participants (mean age: 76.13 years, SD: 7.45, range: 65-95 years) were randomised to either (a) Club Connect, a 10-week group-based multifaceted program, comprising psychoeducation and computer-based cognitive training, or (b) a waitlist control group. RESULTS Implementing group-based cognitive training within a clinical setting was feasible, well tolerated and accepted by participants. Further, cognitive training, in comparison to the waiting list control, was associated with moderate to very large effect size improvements in depression, stress and inhibition (ηp2 = 0.115-0.209). We also found moderate effect size improvements on measures of daily functioning, wellbeing and cognitive flexibility. Small effect size improvements for other cognitive and psychosocial outcomes were also observed. The average cost per person participating in in the intervention was AU$607.50. CONCLUSIONS Our findings support the feasibility of implementing group-based cognitive training into a specialised clinical (public health) setting. This trial was registered on the Australian and New Zealand Clinical Trial Registry (ACTRN12619000195156, 12/02/2019).
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Affiliation(s)
- Claudia Woolf
- Older People's Mental Health Service, St Vincent's Hospital, 390 Victoria St, Darlinghurst, Sydney, NSW, 2010, Australia.
- Healthy Brain Ageing Program, Brain and Mind Centre, The University of Sydney, Camperdown, NSW, Australia.
- Faculty of Science, School of Psychology, The University of Sydney, Camperdown, NSW, Australia.
| | - L Kaplan
- Older People's Mental Health Service, St Vincent's Hospital, 390 Victoria St, Darlinghurst, Sydney, NSW, 2010, Australia
| | - L M Norrie
- Older People's Mental Health Service, St Vincent's Hospital, 390 Victoria St, Darlinghurst, Sydney, NSW, 2010, Australia
- School of Psychiatry, University of New South Wales, Randwick, NSW, Australia
| | - D Burke
- Older People's Mental Health Service, St Vincent's Hospital, 390 Victoria St, Darlinghurst, Sydney, NSW, 2010, Australia
- Discipline of Psychiatry, University of Notre Dame, Sydney, NSW, Australia
- Department of Psychiatry, Trinity College, Dublin, Ireland
| | - M Cunich
- Charles Perkins Centre, The Faculty of Medicine and Health (Central Clinical School), The University of Sydney, Camperdown, NSW, Australia
- Sydney Health Economics Collaborative, Sydney Local Health District, Camperdown, NSW, Australia
| | - L Mowszowski
- Healthy Brain Ageing Program, Brain and Mind Centre, The University of Sydney, Camperdown, NSW, Australia
- Faculty of Science, School of Psychology, The University of Sydney, Camperdown, NSW, Australia
- Charles Perkins Centre, The Faculty of Medicine and Health (Central Clinical School), The University of Sydney, Camperdown, NSW, Australia
| | - S L Naismith
- Older People's Mental Health Service, St Vincent's Hospital, 390 Victoria St, Darlinghurst, Sydney, NSW, 2010, Australia
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Lindbergh CA, Altizer R, Grady JJ, Diniz BS, Kamath J, Steffens DC, Morimoto SS. Computerized cognitive remediation of Long COVID in older adults. Int Psychogeriatr 2024:1-3. [PMID: 38374794 DOI: 10.1017/s1041610224000139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/21/2024]
Affiliation(s)
| | - Roger Altizer
- University of Utah School of Medicine, Salt Lake City, UT, USA
| | - James J Grady
- University of Connecticut School of Medicine, Farmington, CT, USA
| | - Breno S Diniz
- University of Connecticut School of Medicine, Farmington, CT, USA
| | - Jayesh Kamath
- University of Connecticut School of Medicine, Farmington, CT, USA
| | - David C Steffens
- University of Connecticut School of Medicine, Farmington, CT, USA
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Kim J, Park S, Kim H, Roh D, Kim DH. Home-based, Remotely Supervised, 6-Week tDCS in Patients With Both MCI and Depression: A Randomized Double-Blind Placebo-Controlled Trial. Clin EEG Neurosci 2023:15500594231215847. [PMID: 38105601 DOI: 10.1177/15500594231215847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
As depressive symptom is considered a prodrome, a risk factor for progression from mild cognitive impairment (MCI) to dementia, improving depressive symptoms should be considered a clinical priority in patients with MCI undergoing transcranial direct current stimulation (tDCS) intervention. We aimed to comprehensively evaluate the efficacy of the home-based and remotely monitored tDCS in patients with both MCI and depression, by integrating cognitive, psychological, and electrophysiological indicators. In a 6-week, randomized, double blind, and sham-controlled study, 37 community-dwelling patients were randomly assigned to either an active or a sham stimulation group, and received 30 home-based sessions of 2 mA tDCS for 30 min with the anode located over the left and cathode over the right dorsolateral prefrontal cortex. We measured depressive symptoms, neurocognitive function, and resting-state electroencephalography. In terms of effects of both depressive symptoms and cognitive functions, active tDCS was not significantly different from sham tDCS. However, compared to sham stimulation, active tDCS decreased and increased the activation of delta and beta frequencies, respectively. Moreover, the increase in beta activity was correlated with the cognitive enhancement only in the active group. It was not possible to reach a definitive conclusion regarding the efficacy of tDCS on depression and cognition in patients with both MCI and depression. Nevertheless, the relationship between the changes of electrophysiology and cognitive performance suggests potential neuroplasticity enhancement implicated in cognitive processes by tDCS.
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Affiliation(s)
- Jiheon Kim
- Department of Psychiatry, Chuncheon Sacred Heart Hospital, Chuncheon, Republic of Korea
- Mind-Neuromodulation Laboratory, College of Medicine, Hallym University, Chuncheon, Republic of Korea
| | - Seungchan Park
- Mind-Neuromodulation Laboratory, College of Medicine, Hallym University, Chuncheon, Republic of Korea
| | - Hansol Kim
- Mind-Neuromodulation Laboratory, College of Medicine, Hallym University, Chuncheon, Republic of Korea
| | - Daeyoung Roh
- Department of Psychiatry, Chuncheon Sacred Heart Hospital, Chuncheon, Republic of Korea
- Mind-Neuromodulation Laboratory, College of Medicine, Hallym University, Chuncheon, Republic of Korea
| | - Do Hoon Kim
- Department of Psychiatry, Chuncheon Sacred Heart Hospital, Chuncheon, Republic of Korea
- Mind-Neuromodulation Laboratory, College of Medicine, Hallym University, Chuncheon, Republic of Korea
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Zhu Y, Song F, Gu J, Wu L, Wu W, Ji G. Paroxetine induced larva zebrafish cardiotoxicity through inflammation response. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2023; 260:115096. [PMID: 37269614 DOI: 10.1016/j.ecoenv.2023.115096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 05/25/2023] [Accepted: 05/30/2023] [Indexed: 06/05/2023]
Abstract
Paroxetine (PRX) is a common antidepressant drug which widely existence in natural environment. Numerous studies in the past few decades have focused on the beneficial effects of PRX on depression, however, the toxic properties and the potential mechanisms remain unclear. In this study, zebrafish embryos were exposed to 1.0, 5.0, 10 and 20 mg/L of PRX from 4 to 120-hour-post-fertilization (hpf), and it showed that PRX exposure caused adverse effects in zebrafish embryos, including decreased body length, blood flow velocity, cardiac frequency, cardiac output and increased burst activity and atria area. Meanwhile, the Tg (myl7: EGFP) and Tg (lyz: DsRed) transgenic zebrafish were used to detect the cardiotoxicity and inflammation response of PRX. Moreover, the heart development associated genes (vmhc, amhc, hand2, nkx2.5, ta, tbx6, tbx16 and tbx20) and inflammatory genes (IL-10, IL-1β, IL-8 and TNF-α) were up-regulated after PRX challenge. In addition, Aspirin was used to alleviate the PRX-induced heart development disorder. In conclusion, our study verified the PRX induced inflammatory related cardiotoxicity in larva zebrafish. Meanwhile, the current study shown the toxic effects of PRX in aquatic organism, and provide for the environmental safety of PRX.
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Affiliation(s)
- Yuanhui Zhu
- Nanjing Institute of Environmental Sciences, Ministry of Ecology and Environment, Nanjing 210042, China; Department of Toxicology, School of Public Health, Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou 215123, Jiangsu, China
| | - Feifei Song
- Department of Neurology, Zhongshan hospital, Fudan University, 20032 Shanghai, China
| | - Jie Gu
- Nanjing Institute of Environmental Sciences, Ministry of Ecology and Environment, Nanjing 210042, China
| | - Linlin Wu
- Wuxi Center for Disease Control and Prevention, Wuxi 214023, China
| | - Wenzhu Wu
- Nanjing Institute of Environmental Sciences, Ministry of Ecology and Environment, Nanjing 210042, China.
| | - Guixiang Ji
- Nanjing Institute of Environmental Sciences, Ministry of Ecology and Environment, Nanjing 210042, China.
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Klojčnik M, Bakracevic K. The effectiveness of computerized cognitive remediation therapy (CCRT) for deficits in attention and executive functions in depression: A pilot study. APPLIED NEUROPSYCHOLOGY. ADULT 2023; 30:306-314. [PMID: 34182842 DOI: 10.1080/23279095.2021.1941965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Depression is associated with cognitive deficits and changes in the brain. Major depression is often associated with cognitive problems; however, there are only a few studies that have focused on the systematic use of cognitive remediation in depression. The objective of this study was to assess the effectiveness of computerized cognitive remediation in depressed patients with cognitive dysfunction. Patients (n = 20) with depression were randomly assigned to the active or control group. The active intervention (computerized cognitive remediation) comprised 12 sessions focused on the remediation of attention and executive functions through the CogniPlus software. All participants completed neuropsychological testing before and after the intervention. A mixed-design analysis of variance revealed a significant time × group interaction in the attention and planning task, on the Beck Depression Inventory and on the Shifting, Emotional Control and Initiating sub-scales of the Behavior Rating Inventory of Executive Function-Adult. The results showed that patients undergoing cognitive remediation improved in domains related to attention and executive functions and scored significantly lower on the Beck Depression Inventory. The findings provide some evidence that cognitive remediation could be an efficient approach to dealing with cognitive deficits in depression.
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Affiliation(s)
- Monika Klojčnik
- Faculty of Arts, Department of Psychology, University of Maribor, Maribor, Slovenia
| | - Karin Bakracevic
- Faculty of Arts, Department of Psychology, University of Maribor, Maribor, Slovenia
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Vega JN, Newhouse PA, Conley AC, Szymkowicz SM, Gong X, Cote S, Mayer I, Taylor WD, Morimoto SS. Use of focused computerized cognitive training (Neuroflex) to improve symptoms in women with persistent chemotherapy-related cognitive impairment. Digit Health 2023; 9:20552076231192754. [PMID: 37588161 PMCID: PMC10426301 DOI: 10.1177/20552076231192754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 07/18/2023] [Indexed: 08/18/2023] Open
Abstract
Purpose Chemotherapy-related cognitive impairment (CRCI) is a distressing and increasingly recognized long-term sequela reported by breast cancer patients following cancer treatment. There is an urgent but unmet clinical need for treatments that improve CRCI. In this context, we proposed the use of a novel cognitive enhancement strategy called Neuroflex to target CRCI experienced by breast cancer survivors. Methods The primary aim of this pilot study was to evaluate the feasibility and acceptability of Neuroflex, a novel digital cognitive enhancement strategy, in breast and gynecologic cancer survivors with CRCI. Secondary analyses focused on whether improvements in performance on Neuroflex were associated with improvement in subjective cognitive complaints and objective cognitive performance measures. Results Participants (N = 21) completed an average of 7.42 hours of Neuroflex training per week, an average of 44.5 (±1.01) hours total, and had a 100% completion rate. Participants exhibited significant improvement in self-reported cognitive function as well as significant improvement on tasks of verbal learning and memory and auditory working memory. Participants also exhibited improvement in mood, as well as improvement on a disability assessment. Conclusions Results demonstrate feasibility and that breast cancer survivors are capable of completing a lengthy and challenging cognitive training program. Secondly, Neuroflex may confer specific cognitive benefits to both self-reported and objective performance. Results strongly support further investigation of Neuroflex in a larger controlled trial to establish efficacy for CRCI symptoms. Further studies may also result in optimization of this digital intervention for women with CRCI.
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Affiliation(s)
- Jennifer N. Vega
- Center for Cognitive Medicine, Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Paul A. Newhouse
- Center for Cognitive Medicine, Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
- Geriatric Research, Education, and Clinical Center, Veterans Affairs Tennessee Valley Health System, Nashville, TN, USA
| | - Alexander C. Conley
- Center for Cognitive Medicine, Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sarah M. Szymkowicz
- Center for Cognitive Medicine, Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Xuewen Gong
- Center for Cognitive Medicine, Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sarah Cote
- Department of Population Health Sciences, Division of Health Systems Innovation and Research, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Ingrid Mayer
- Department of Medicine, Vanderbilt University Medical Center/Vanderbilt–Ingram Cancer Center, Nashville, TN, USA
| | - Warren D. Taylor
- Center for Cognitive Medicine, Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
- Geriatric Research, Education, and Clinical Center, Veterans Affairs Tennessee Valley Health System, Nashville, TN, USA
| | - Sarah Shizuko Morimoto
- Department of Population Health Sciences, Division of Health Systems Innovation and Research, University of Utah School of Medicine, Salt Lake City, UT, USA
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Targeting disrupted rich-club network organization with neuroplasticity-based computerized cognitive remediation in major depressive disorder patients. Psychiatry Res 2022; 316:114742. [PMID: 35917652 DOI: 10.1016/j.psychres.2022.114742] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 07/17/2022] [Accepted: 07/21/2022] [Indexed: 11/24/2022]
Abstract
Disrupted rich-club organization has been extensively studied in major depressive disorder (MDD) patients. Although data indicate that neuroplasticity-based computerized cognitive remediation (nCCR) can accelerate clinical responses in MDD patients, the mechanisms underlying its antidepressant efficacy are unknown. In this study, all MDD patients underwent two (baseline and week 4) neuropsychological assessments and DTI imaging. Additionally, 17 MDD patients did nCCR for 30 hours spread across 4 weeks. Rich-club organization was calculated with a graph-theoretical approach, and SC-FC coupling was explored. After 4 weeks of treatment, the number of rich-club connections, global efficiency, and SC-FC coupling strength increased significantly and were negatively associated with TMT-B scores. The effects of nCCR on disrupted rich-club organization may partly underlie its efficacy in improving the executive function of patients with MDD. Effects of nCCR on disrupted rich-club organization may partly underlie its efficacy in improving the executive function of patients with MDD.
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Depression, Depression Treatments, and Risk of Incident Dementia: A Prospective Cohort Study of 354,313 Participants. Biol Psychiatry 2022; 93:802-809. [PMID: 36526487 DOI: 10.1016/j.biopsych.2022.08.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 08/05/2022] [Accepted: 08/29/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND The purpose of this study was to investigate the associations between courses of depression, the application of depression treatment, and the risk of incident dementia. METHODS In this prospective cohort study, 354,313 participants ages 50-70 years were recruited from the UK Biobank between 2006 and 2010 and were followed until 2020, with a total of 4,212,929 person-years. We initially studied the effect of depression on dementia incidence across 4 subgroups characterized by courses of depressive symptoms. Then, 46,820 participants with a diagnosis of depression were further categorized into treated and untreated groups. We compared the risk of dementia among different depression treatment groups in all participants who were depressed as well as 4 courses of depressive symptoms by performing survival analyses. RESULTS Depression was associated with a 51% higher risk of dementia, among which the increasing, chronically high, and chronically low courses were associated with increased dementia risk, while no association was found in the decreasing course. Compared to those who were depressed but untreated, receiving depression treatments corresponded to a hazard ratio of 0.7 (95% CI, 0.62-0.77). Among the 3 detrimental courses, treatments for increasing and chronically low symptoms of depression were associated with a 32% and 28% lower risk of dementia, respectively, while the reduction effect for chronically high symptoms was insignificant. CONCLUSIONS The negative association between depression treatment and incident dementia was significant in the increasing and chronically low courses, highlighting the necessity of timely interventional strategies before depression progresses to a chronically severe state.
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Sociali A, Borgi M, Pettorruso M, Di Carlo F, Di Natale C, Tambelli A, Alessi MC, Ciavoni L, Mosca A, Miuli A, Sensi SL, Martinotti G, Zoratto F, Di Giannantonio M. What role for cognitive remediation in the treatment of depressive symptoms? A superiority and noninferiority meta-analysis for clinicians. Depress Anxiety 2022; 39:586-606. [PMID: 35536033 DOI: 10.1002/da.23263] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 01/23/2022] [Accepted: 04/16/2022] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Cognitive remediation (CR) is a promising technique in the treatment of the cognitive dimension of depression. The present study evaluated the potential of CR in treating depressive symptoms and provides practical information about its usefulness in clinical settings. METHODS We performed two meta-analyses of published randomized (and nonrandomized) clinical trials, comparing CR to control conditions in subjects with current depressive symptomatology. The superiority meta-analysis aimed to determine the superiority of CR when compared with placebo/waiting list interventions and its efficacy when used as an augmentation therapy. The noninferiority meta-analysis determined whether CR had noninferior efficacy compared with standard antidepressant interventions. RESULTS CR was found to significantly improve depressive symptomatology in the superiority meta-analysis (CR: n = 466, control n = 478). Moreover, CR seemed to be noninferior to standard antidepressant interventions (CR: n = 230, control n = 235). CR was more effective when addressing hot (vs. cold) cognition, when involving younger patients (i.e., <30 years), and in the case of mild-moderate (vs. severe) depression. CONCLUSIONS CR should be considered an augmentation treatment to improve treatment outcomes in depressed subjects, especially among young individuals. Interventions addressing hot cognition seem to be the most promising.
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Affiliation(s)
- Antonella Sociali
- Department of Neuroscience, Imaging, Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Marta Borgi
- Center for Behavioral Sciences and Mental Health, Istituto Superiore di Sanità, Rome, Italy
| | - Mauro Pettorruso
- Department of Neuroscience, Imaging, Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy.,Department of Mental Health, ASL Lanciano-Vasto-Chieti, Chieti, Italy
| | - Francesco Di Carlo
- Department of Neuroscience, Imaging, Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Chiara Di Natale
- Department of Neuroscience, Imaging, Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Antonio Tambelli
- Department of Neuroscience, Imaging, Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Maria C Alessi
- Department of Neuroscience, Imaging, Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Laura Ciavoni
- Department of Neuroscience, Imaging, Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Alessio Mosca
- Department of Neuroscience, Imaging, Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Andrea Miuli
- Department of Mental Health, ASL Lanciano-Vasto-Chieti, Chieti, Italy
| | - Stefano L Sensi
- Department of Neuroscience, Imaging, Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Giovanni Martinotti
- Department of Neuroscience, Imaging, Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy.,Department of Clinical and Pharmaceutical Sciences, University of Hertfordshire, Herts, UK
| | - Francesca Zoratto
- Center for Behavioral Sciences and Mental Health, Istituto Superiore di Sanità, Rome, Italy
| | - Massimo Di Giannantonio
- Department of Neuroscience, Imaging, Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy
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Mindfulness-Enhanced Computerized Cognitive Training for Depression: An Integrative Review and Proposed Model Targeting the Cognitive Control and Default-Mode Networks. Brain Sci 2022; 12:brainsci12050663. [PMID: 35625049 PMCID: PMC9140161 DOI: 10.3390/brainsci12050663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 05/16/2022] [Accepted: 05/17/2022] [Indexed: 11/16/2022] Open
Abstract
Depression is often associated with co-occurring neurocognitive deficits in executive function (EF), processing speed (PS) and emotion regulation (ER), which impact treatment response. Cognitive training targeting these capacities results in improved cognitive function and mood, demonstrating the relationship between cognition and affect, and shedding light on novel targets for cognitive-focused interventions. Computerized cognitive training (CCT) is one such new intervention, with evidence suggesting it may be effective as an adjunct treatment for depression. Parallel research suggests that mindfulness training improves depression via enhanced ER and augmentation of self-referential processes. CCT and mindfulness training both act on anti-correlated neural networks involved in EF and ER that are often dysregulated in depression—the cognitive control network (CCN) and default-mode network (DMN). After practicing CCT or mindfulness, downregulation of DMN activity and upregulation of CCN activity have been observed, associated with improvements in depression and cognition. As CCT is posited to improve depression via enhanced cognitive function and mindfulness via enhanced ER ability, the combination of both forms of training into mindfulness-enhanced CCT (MCCT) may act to improve depression more rapidly. MCCT is a biologically plausible adjunct intervention and theoretical model with the potential to further elucidate and target the causal mechanisms implicated in depressive symptomatology. As the combination of CCT and mindfulness has not yet been fully explored, this is an intriguing new frontier. The aims of this integrative review article are four-fold: (1) to briefly review the current evidence supporting the efficacy of CCT and mindfulness in improving depression; (2) to discuss the interrelated neural networks involved in depression, CCT and mindfulness; (3) to present a theoretical model demonstrating how MCCT may act to target these neural mechanisms; (4) to propose and discuss future directions for MCCT research for depression.
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13
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Mendes L, Oliveira J, Barbosa F, Castelo-Branco M. A Conceptual View of Cognitive Intervention in Older Adults With and Without Cognitive Decline-A Systemic Review. FRONTIERS IN AGING 2022; 3:844725. [PMID: 35821828 PMCID: PMC9261456 DOI: 10.3389/fragi.2022.844725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 02/28/2022] [Indexed: 11/17/2022]
Abstract
Background: Dementia is the one of the most common and prominent disease in the elderly person that results in the Cognitive interventions. In this study, we aim to conceptualize the cognitive intervention for older adults with and without cognitive dysfunction and to clarify the heterogeneity existing in this literature field by determining the main variables implicated. Methods: We conducted a study analysis using previous literature highlighting the significant data reporting empirical results from cognitive intervention for healthy older adults and other seniors with different types of dementia. Each paper was reviewed in terms of compensatory cognitive training, cognitive remediation, enrichment, cognitive activation, brain training, cognitive stimulation, cognitive training, and cognitive rehabilitation. The research analysis was performed following rigorous inclusion and exclusion criteria with the purpose of collecting relevant answers to our research questions. Results: We included a total of 168 studies in our review. Our findings indicated heterogeneity regarding methods, concepts, and procedures. Additionally, the values were integrated using different information existing in this field. Conclusion: In conclusion, we highlighted that this is the first review that clarify the discrepancy of various existing definitions, methods, and procedures, as well as the overlapping information in the cognitive interventions.
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Affiliation(s)
- Liliana Mendes
- Coimbra Institute for Clinical and Biomedical Research, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Joana Oliveira
- Coimbra Institute for Clinical and Biomedical Research, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Fernando Barbosa
- Faculty of Psychology and Education Science, University of Porto, Porto, Portugal
| | - Miguel Castelo-Branco
- Coimbra Institute for Clinical and Biomedical Research, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
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14
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TIBA AI, VOSS L. " A Motor Imagery Training for Improving Action Cognition Results in the Reduction of Residual Symptoms after Major Depressive Disorder: A Single-Case Study". JOURNAL OF EVIDENCE-BASED PSYCHOTHERAPIES 2022. [DOI: 10.24193/jebp.2022.1.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The high rate of recurrence and residual symptoms of depression continuously motivate the search for new treatments addressing this challenging condition. In this single-case study, we reported the application of a cognitive rehabilitation skills training based on remote kinematics as a treatment for residual depression by targeting deficits of mental simulations of action. We found that the administration of Kinect-based rehabilitation training resulted in important improvements showed by significant mean baseline reductions (MBLR) of difficulty in imagining positive actions (MBLR= 54 %), negative emotions (MBLR = 36.3 %), cognitive flexibility (MBLR= 69.7 %), depressive symptoms (MBLR= 80%), and physical retardation (MBLR= 50 %). Similarly, improvements in positive affect (MBLR = 107 %) and vividness of motor imagery for positive actions were registered (MBLR= 100 %). We also found unique effects of our intervention such as reports of involuntary action simulations to distant stimuli or extended affordances. The training was well-accepted and the patient considered it was an entertaining way to do physical exercises and to get in physical and mental shape. We concluded that further scientific research of remote Kinematic interventions in depression may be warranted.
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15
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Edwards EJ, Zec D, Campbell M, Hoorelbeke K, Koster EHW, Derakshan N, Wynne J. Cognitive control training for children with anxiety and depression: A systematic review. J Affect Disord 2022; 300:158-171. [PMID: 34983006 DOI: 10.1016/j.jad.2021.12.108] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 12/20/2021] [Accepted: 12/24/2021] [Indexed: 10/19/2022]
Abstract
Cognitive control training has gained traction as an intervention for reducing anxiety and depression vulnerability in adults. There are, however, a limited number of studies investigating such training interventions for reducing symptomology of anxiety and depression in children and adolescents. Thus, we aimed to provide a robust review and qualitative synthesis of the available research in young people. Twelve articles met the inclusion criteria, and all were randomised control trials. Evidence of the efficacy of cognitive control training for relief of symptoms are reported separately for anxiety, depression, and other related psychological factors, and on the basis of type of cognitive control training paradigm. A lack of standardisation in relation to type of intervention, duration and context, outcome measures and population was observed. Results are discussed in terms of these variations and recommendations for future research are provided.
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Affiliation(s)
| | - Dajana Zec
- School of Education, The University of Queensland, QLD 4072, Australia
| | - Marilyn Campbell
- School of Early Childhood and Inclusive Education, Queensland University of Technology, Brisbane, Australia
| | - Kristof Hoorelbeke
- Department of Experimental Clinical and Health Psychology, Ghent University, Belgium
| | - Ernst H W Koster
- Department of Experimental Clinical and Health Psychology, Ghent University, Belgium
| | - Nazanin Derakshan
- Department of Psychological Science, Birkbeck University College of London, United Kingdom
| | - Jeffrey Wynne
- School of Education, The University of Queensland, QLD 4072, Australia
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16
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Wexler BE. Returning to basic principles to develop more effective treatments for central nervous system disorders. Exp Biol Med (Maywood) 2022; 247:856-867. [PMID: 35172621 PMCID: PMC9158240 DOI: 10.1177/15353702221078291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Development of new treatments for diseases of the central nervous system (CNS) is
stalled. Of candidate drugs developed through costly preclinical research, 93%
fail clinical trials. Hoped-for improvements in diagnosis or treatment from
decades of positron emission tomography (PET) and functional magnetic resonance
imaging (fMRI) imaging have yet to materialize. To understand what we are doing
wrong, I begin with recognition that all aspects of life, including the brain
and mind, are physical phenomena consistent with processes described by
physicists. Two processes, emergence and entropy, are of particular relevance in
complex arrangements of matter that constitute life in general and the brain in
particular. The human brain functions through dynamically reconfiguring and
hierarchically organized neural functional systems with emergent properties of
cognition, emotion, and conscious experience. These systems are shaped and
maintained by negentropic environmental input transformed by sensory receptors
into neural signals that trigger epigenetic neuroplastic processes. CNS diseases
produce clinical disorders by disrupting these systems. As researchers seek
appropriate levels of system organization at which to characterize and treat
illness, focus has been on medications that impact processes at lower levels or
transcranial electric or magnetic stimulation that impact broad contiguous
swaths of tissue. Neither align with the brain’s neurosystem organization and
therefore lack specificity necessary to be effective and to limit side effects.
Digital neurotherapies (DNTs), in contrast, align with neurosystem organization
and achieve the needed specificity using the same input pathways and
neuroplastic processes that created the neural systems organization to repair
it. The omission of DNTs from major systems-based initiatives represents
powerful residua of dualist thinking. Interventions based on perceptual and
cognitive processes are not thought of as being as physical as drugs or electric
or magnetic stimulation through the skull. In fact, they are examples of the
most basic processes that create and support life itself.
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17
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Hoorelbeke K, Vervaeke J, Siegle GJ, Baeken C, Koster EH. Individual differences associated with treatment adherence and transfer effects following gamified web-based cognitive control training for repetitive negative thinking. Internet Interv 2022; 27:100507. [PMID: 35242588 PMCID: PMC8859013 DOI: 10.1016/j.invent.2022.100507] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 02/08/2022] [Accepted: 02/09/2022] [Indexed: 12/27/2022] Open
Abstract
Recent research suggests beneficial effects of cognitive control training (CCT) on repetitive negative thinking (RNT), a key risk factor for internalizing symptomatology. However, relatively little is known regarding predictors of adherence to internet-delivered CCT as well as moderators of treatment effects for this intervention. Answering these questions could improve efficiency of clinical implementation of CCT as an eHealth intervention. The current pre-registered single-arm trial set-out to address these questions using a web-based gamified CCT procedure based on the adaptive Paced Auditory Serial Addition Task. Participants (N = 382) entered the internet-based study, where we observed considerable drop-out during the assessment phase and the first training sessions. Emotional stability and resilience emerged as predictors for deciding not to commence the intervention. Drop-out throughout the course of CCT was explained by age, emotion regulation-, and personality factors. We used latent profile analysis, a probabilistic modeling approach, to identify clusters of participants (User Profiles) based on indicators of baseline cognitive- and emotional functioning, training progress, and user experience. We obtained three User Profiles, reflecting low-, moderate-, and high-risk status. Effortful control, emotion regulation, internalizing symptomatology, resilience, and emotional stability played a central role in these User Profiles. Interestingly, User Profile predicted training related cognitive gains, as well as effects of CCT on anxiety- and stress symptoms, and reappraisal. Our findings suggest that CCT is most effective for the moderate- and high-risk groups. In addition, the high-risk group would likely benefit from a more intensive training procedure or repeated administration of the training procedure over time to foster long-term retention of training related gains.
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Affiliation(s)
- Kristof Hoorelbeke
- Psychopathology and Affective Neuroscience (PAN) lab, Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium,Corresponding author at: Henri-Dunantlaan 2, 9000 Ghent, Belgium.
| | - Jasmien Vervaeke
- Psychopathology and Affective Neuroscience (PAN) lab, Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium,Imec-Mict-Ghent University, Ghent, Belgium
| | - Greg J. Siegle
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Chris Baeken
- Department of Head and Skin (UZGent), Ghent Experimental Psychiatry (GHEP) Lab, Ghent University, Ghent, Belgium,Department of Psychiatry (UZBrussel), Vrije Universiteit Brussel (VUB), Brussels, Belgium,Department of Electrical Engineering, Eindhoven University of Technology, the Netherlands
| | - Ernst H.W. Koster
- Psychopathology and Affective Neuroscience (PAN) lab, Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium
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18
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Belvederi Murri M, Grassi L, Caruso R, Nanni MG, Zerbinati L, Andreas S, Ausín B, Canuto A, Härter M, Lopez MM, Weber K, Wittchen HU, Volkert J, Alexopoulos GS. Depressive symptom complexes of community-dwelling older adults: a latent network model. Mol Psychiatry 2022; 27:1075-1082. [PMID: 34642459 DOI: 10.1038/s41380-021-01310-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 03/23/2021] [Accepted: 09/15/2021] [Indexed: 11/09/2022]
Abstract
Late-life depression has multiple, heterogeneous clinical presentations. The aim of the study was to identify higher-order homogeneous clinical features (symptom complexes), while accounting for their potential causal interactions within the network approach to psychopathology. We analyzed cross-sectional data from community-dwelling adults aged 65-85 years recruited by the European MentDis_ICF65+ study (n = 2623, mean age 74, 49% females). The severity of 33 depressive symptoms was derived from the age-adapted Composite International Diagnostic Interview. Symptom complexes were identified using multiple detection algorithms for symptom networks, and their fit to data was assessed with latent network models (LNMs) in exploratory and confirmatory analyses. Sensitivity analyses included the Partial Correlation Likelihood Test (PCLT) to investigate the data-generating structure. Depressive symptoms were organized by the Walktrap algorithm into eight symptom complexes, namely sadness/hopelessness, anhedonia/lack of energy, anxiety/irritability, self-reproach, disturbed sleep, agitation/increased appetite, concentration/decision making, and thoughts of death. An LNM adequately fit the distribution of individual symptoms' data in the population. The model suggested the presence of reciprocal interactions between the symptom complexes of sadness and anxiety, concentration and self-reproach and between self-reproach and thoughts of death. Results of the PCLT confirmed that symptom complex data were more likely generated by a network, rather than a latent-variable structure. In conclusion, late-life depressive symptoms are organized into eight interacting symptom complexes. Identification of the symptom complexes of late-life depression may streamline clinical assessment, provide targets for personalization of treatment, and aid the search for biomarkers and for predictors of outcomes of late-life depression.
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Affiliation(s)
- Martino Belvederi Murri
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - Luigi Grassi
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - Rosangela Caruso
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - Maria Giulia Nanni
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - Luigi Zerbinati
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - Sylke Andreas
- Department of Medical Psychology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.,Institute for Psychology, Universität Klagenfurt, A-9020, Klagenfurt, Austria
| | - Berta Ausín
- School of Psychology, Personality, Evaluation and Clinical Psychology Department, University Complutense of Madrid, Campus de Somosaguas s/n, 28223, Madrid, Spain
| | - Alessandra Canuto
- Division of Institutional Measures, University Hospitals of Geneva, 1208, Geneva, Switzerland
| | - Martin Härter
- Department of Medical Psychology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Manuel Muñoz Lopez
- School of Psychology, Personality, Evaluation and Clinical Psychology Department, University Complutense of Madrid, Campus de Somosaguas s/n, 28223, Madrid, Spain
| | - Kerstin Weber
- Division of Institutional Measures, University Hospitals of Geneva, 1208, Geneva, Switzerland
| | - Hans-Ulrich Wittchen
- Clinical Psychology & Psychotherapy RG, Department of Psychiatry & Psychotherapy, Ludwig-Maximilians-Universität, Munich, Germany
| | - Jana Volkert
- Department of Psychosocial Prevention, University of Heidelberg, Bergheimer Str. 54, 69115, Heidelberg, Germany.,Institute of Psychology, University of Kassel, Holländische Str. 36-38, 34127, Kassel, Germany
| | - George S Alexopoulos
- Weill Cornell Institute of Geriatric Psychiatry, Weill Cornell Medicine, White Plains, NY, USA.
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19
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Influences of dopaminergic system dysfunction on late-life depression. Mol Psychiatry 2022; 27:180-191. [PMID: 34404915 PMCID: PMC8850529 DOI: 10.1038/s41380-021-01265-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 07/28/2021] [Accepted: 08/04/2021] [Indexed: 12/15/2022]
Abstract
Deficits in cognition, reward processing, and motor function are clinical features relevant to both aging and depression. Individuals with late-life depression often show impairment across these domains, all of which are moderated by the functioning of dopaminergic circuits. As dopaminergic function declines with normal aging and increased inflammatory burden, the role of dopamine may be particularly salient for late-life depression. We review the literature examining the role of dopamine in the pathogenesis of depression, as well as how dopamine function changes with aging and is influenced by inflammation. Applying a Research Domain Criteria (RDoC) Initiative perspective, we then review work examining how dopaminergic signaling affects these domains, specifically focusing on Cognitive, Positive Valence, and Sensorimotor Systems. We propose a unified model incorporating the effects of aging and low-grade inflammation on dopaminergic functioning, with a resulting negative effect on cognition, reward processing, and motor function. Interplay between these systems may influence development of a depressive phenotype, with an initial deficit in one domain reinforcing decline in others. This model extends RDoC concepts into late-life depression while also providing opportunities for novel and personalized interventions.
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20
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Jaywant A, DelPonte L, Kanellopoulos D, O'Dell MW, Gunning FM. The Structural and Functional Neuroanatomy of Post-Stroke Depression and Executive Dysfunction: A Review of Neuroimaging Findings and Implications for Treatment. J Geriatr Psychiatry Neurol 2022; 35:3-11. [PMID: 33073704 DOI: 10.1177/0891988720968270] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Post-stroke depression and executive dysfunction co-occur and are highly debilitating. Few treatments alleviate both depression and executive dysfunction after stroke. Understanding the brain network changes underlying post-stroke depression with executive dysfunction can inform the development of targeted and efficacious treatment. In this review, we synthesize neuroimaging findings in post-stroke depression and post-stroke executive dysfunction and highlight the network commonalities that may underlie this comorbidity. Structural and functional alterations in the cognitive control network, salience network, and default mode network are associated with depression and executive dysfunction after stroke. Specifically, post-stroke depression and executive dysfunction are both linked to changes in intrinsic functional connectivity within resting state networks, functional over-connectivity between the default mode and salience/cognitive control networks, and reduced cross-hemispheric frontoparietal functional connectivity. Cognitive training and noninvasive brain stimulation targeted at these brain network abnormalities and specific clinical phenotypes may help advance treatment for post-stroke depression with executive dysfunction.
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Affiliation(s)
- Abhishek Jaywant
- Department of Psychiatry, Weill Cornell Medicine, New York, NY, USA.,Department of Rehabilitation Medicine, Weill Cornell Medicine, New York, NY, USA.,NewYork-Presbyterian Hospital, New York, NY, USA
| | - Larissa DelPonte
- Department of Psychiatry, Weill Cornell Medicine, New York, NY, USA
| | - Dora Kanellopoulos
- Department of Psychiatry, Weill Cornell Medicine, New York, NY, USA.,NewYork-Presbyterian Hospital, New York, NY, USA.,Weill Cornell Institute of Geriatric Psychiatry, White Plains, NY, USA
| | - Michael W O'Dell
- Department of Rehabilitation Medicine, Weill Cornell Medicine, New York, NY, USA.,NewYork-Presbyterian Hospital, New York, NY, USA
| | - Faith M Gunning
- Department of Psychiatry, Weill Cornell Medicine, New York, NY, USA.,NewYork-Presbyterian Hospital, New York, NY, USA.,Weill Cornell Institute of Geriatric Psychiatry, White Plains, NY, USA
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21
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Wang C, Cardenas A, Hutchinson JN, Just A, Heiss J, Hou L, Zheng Y, Coull BA, Kosheleva A, Koutrakis P, Baccarelli AA, Schwartz JD. Short- and intermediate-term exposure to ambient fine particulate elements and leukocyte epigenome-wide DNA methylation in older men: the Normative Aging Study. ENVIRONMENT INTERNATIONAL 2022; 158:106955. [PMID: 34717175 PMCID: PMC8710082 DOI: 10.1016/j.envint.2021.106955] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 10/18/2021] [Accepted: 10/22/2021] [Indexed: 05/08/2023]
Abstract
BACKGROUND Several epigenome-wide association studies (EWAS) of ambient particulate matter with aerodynamic diameter ≤ 2.5 µm (PM2.5) have been reported. However, EWAS of PM2.5 elements (PEs), reflecting different emission sources, are very limited. OBJECTIVES We performed EWAS of short- and intermediate-term exposure to PM2.5 and 13 PEs. We hypothesized that significant changes in DNAm may vary by PM2.5 mass and its elements. METHODS We repeatedly collected blood samples in the Normative Aging Study and measured leukocyte DNA methylation (DNAm) with the Illumina HumanMethylation450K BeadChip. We collected daily PM2.5 and 13 PEs at a fixed central site. To estimate the associations between each PE and DNAm at individual cytosine-phosphate-guanine (CpG) sites, we incorporated a distributed-lag (0-27 d) term in the setting of median regression with subject-specific intercept and examined cumulative lag associations. We also accounted for selection bias due to loss to follow-up and mortality prior to enrollment. Significantly differentially methylated probes (DMPs) were identified using Bonferroni correction for multiple testing. We further conducted regional and pathway analyses to identify significantly differentially methylated regions (DMRs) and pathways. RESULTS We included 695 men with 1,266 visits between 1999 and 2013. The subjects had a mean age of 75 years. The significant DMPs, DMRs, and pathways varied by to PM2.5 total mass and PEs. For example, PM2.5 total mass was associated with 2,717 DMPs and 10,470 DMRs whereas Pb was associated with 3,173 DMPs and 637 DMRs. The identified pathways by PM2.5 mass were mostly involved in mood disorders, neuroplasticity, immunity, and inflammation, whereas the pathways associated with motor vehicles (BC, Cu, Pb, and Zn) were related with cardiovascular disease and cancer (e.g., "PPARs signaling"). CONCLUSIONS PM2.5 and PE were associated with methylation changes at multiple probes and along multiple pathways, in ways that varied by particle components.
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Affiliation(s)
- Cuicui Wang
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA.
| | - Andres Cardenas
- Division of Environmental Health Sciences, School of Public Health and Center for Computational Biology, University of California, Berkeley, Berkeley, CA 94720, USA
| | - John N Hutchinson
- Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA 02115, USA
| | - Allan Just
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Jonathan Heiss
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Lifang Hou
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Yinan Zheng
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Brent A Coull
- Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA 02115, USA
| | - Anna Kosheleva
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
| | - Petros Koutrakis
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
| | - Andrea A Baccarelli
- Department of Environmental Health Sciences, Columbia Mailman School of Public Health, New York, NY 10032, USA
| | - Joel D Schwartz
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
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22
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Improved emotion regulation in depression following cognitive remediation: A randomized controlled trial. Behav Res Ther 2021; 147:103991. [PMID: 34740101 DOI: 10.1016/j.brat.2021.103991] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 08/23/2021] [Accepted: 10/25/2021] [Indexed: 01/18/2023]
Abstract
OBJECTIVE Executive functions (EFs) play a key role in emotion regulation and, related to this, depression. Cognitive remediation (CR) targeting EFs, such as Goal Management Training (GMT) and computerized cognitive training (CCT), may reduce maladaptive emotion regulation. However, the clinical potential of GMT in the context of depression and emotion regulation remains to be tested. Hence, the primary aim of the present study was to compare effects of GMT with CCT on symptoms of emotion dysregulation. METHOD The paper reports the effects of a preregistered randomized controlled trial. Sixty-three participants (18-60yrs) with active or remitted depression and EF complaints were randomized to nine sessions of GMT (n = 35) or CCT (n = 28). All were assessed at baseline, post-intervention, and at 6-month follow-up. The Ruminative Response Scale and the Difficulties in Emotion Regulation Scale were employed to assess emotion regulation. RESULTS Both groups improved following the intervention on emotion regulation domains after controlling for intention-to-treat, including brooding rumination and on items reflecting non-accepting reactions to distress. Relative to CCT, the GMT-group demonstrated increased clarity of emotional responses in the per protocol analysis. CONCLUSIONS Our findings demonstrate the potential of GMT and CCT in reducing maladaptive emotion regulation in depression.
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23
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Husain-Krautter S, Ellison JM. Late Life Depression: The Essentials and the Essential Distinctions. FOCUS: JOURNAL OF LIFE LONG LEARNING IN PSYCHIATRY 2021; 19:282-293. [PMID: 34690594 DOI: 10.1176/appi.focus.20210006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Late life depression (LLD), a familiar syndrome, is not differentiated in the DSM-5. LLD can resemble depressive syndromes in younger adults but it differs in demographic characteristics, phenomenology, prognosis, treatment, suicide risk, relationship to other disorders, and etiology. Older depressed adults often present with fewer major depressive symptoms, less emphasis on mood disturbance, greater preoccupation with somatic or psychotic symptoms, and misleading cognitive deficits. LLD's relationships with medical and neurocognitive symptoms and with inflammatory and immune factors are complex. Formal screening tools and biopsychosocial assessment informs diagnosis and treatment. Evidence supports the effectiveness of lifestyle interventions, several psychotherapies, and a variety of somatic treatment approaches. Comorbid medical disorders must be taken into account when planning treatment. In this article, the authors describe the characteristics of LLD, present an approach to assessment and management, and recommend that future DSM editions include a new specifier to differentiate LLD from other depressive syndromes.
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Affiliation(s)
- Sehba Husain-Krautter
- Zucker Hillside Hospital, North Shore, Long Island Jewish Health System, Glen Oaks, New York (Husain-Krautter); Litwin-Zucker Research Center for the Study of Alzheimer's Disease, Feinstein Institute for Medical Research, Manhasset, New York (Husain-Krautter); Swank Center for Memory Care and Geriatric Consultation, ChristianaCare, Wilmington, Delaware (Ellison); Sidney Kimmel College of Medicine, Thomas Jefferson University, Philadelphia (Ellison)
| | - James M Ellison
- Zucker Hillside Hospital, North Shore, Long Island Jewish Health System, Glen Oaks, New York (Husain-Krautter); Litwin-Zucker Research Center for the Study of Alzheimer's Disease, Feinstein Institute for Medical Research, Manhasset, New York (Husain-Krautter); Swank Center for Memory Care and Geriatric Consultation, ChristianaCare, Wilmington, Delaware (Ellison); Sidney Kimmel College of Medicine, Thomas Jefferson University, Philadelphia (Ellison)
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Wexler BE, Vitulano LA, Moore C, Katsovich L, Smith SD, Rush C, Grantz H, Dong J, Leckman JF. An integrated program of computer-presented and physical cognitive training exercises for children with attention-deficit/hyperactivity disorder. Psychol Med 2021; 51:1524-1535. [PMID: 32090720 DOI: 10.1017/s0033291720000288] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND This study integrated an experimental medicine approach and a randomized cross-over clinical trial design following CONSORT recommendations to evaluate a cognitive training (CT) intervention for attention deficit hyperactivity disorder (ADHD). The experimental medicine approach was adopted because of documented pathophysiological heterogeneity within the diagnosis of ADHD. The cross-over design was adopted to provide the intervention for all participants and make maximum use of data. METHODS Children (n = 93, mean age 7.3 +/- 1.1 years) with or sub-threshold for ADHD were randomly assigned to CT exercises over 15 weeks, before or after 15 weeks of treatment-as-usual (TAU). Fifteen dropped out of the CT/TAU group and 12 out of the TAU/CT group, leaving 66 for cross-over analysis. Seven in the CT/TAU group completed CT before dropping out making 73 available for experimental medicine analyses. Attention, response inhibition, and working memory were assessed before and after CT and TAU. RESULTS Children were more likely to improve with CT than TAU (27/66 v. 13/66, McNemar p = 0.02). Consistent with the experimental medicine hypotheses, responders improved on all tests of executive function (p = 0.009-0.01) while non-responders improved on none (p = 0.27-0.81). The degree of clinical improvement was predicted by baseline and change scores in focused attention and working memory (p = 0.008). The response rate was higher in inattentive and combined subtypes than hyperactive-impulsive subtype (p = 0.003). CONCLUSIONS Targeting cognitive dysfunction decreases clinical symptoms in proportion to improvement in cognition. Inattentive and combined subtypes were more likely to respond, consistent with targeted pathology and clinically relevant heterogeneity within ADHD.
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Affiliation(s)
- Bruce E Wexler
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | | | - Christina Moore
- Child Study Center, Yale School of Medicine, New Haven, CT, USA
- Department of Psychology, University of Delaware, Newark, DE, USA
| | | | - Stephanie D Smith
- Child Study Center, Yale School of Medicine, New Haven, CT, USA
- Department of Psychology, University of Southern Mississippi, Hattiesburg, MS, USA
| | - Cindy Rush
- Department of Statistics, Columbia University, New York, NY, USA
| | - Heidi Grantz
- Child Study Center, Yale School of Medicine, New Haven, CT, USA
| | | | - James F Leckman
- Child Study Center, Yale School of Medicine, New Haven, CT, USA
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25
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Alexopoulos GS. Mechanisms and Treatment of Late-Life Depression. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2021; 19:340-354. [PMID: 34690604 DOI: 10.1176/appi.focus.19304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
(Appeared originally in Translational Psychiatry 2019; 9:188).
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Affiliation(s)
- George S Alexopoulos
- Weill Cornell Institute of Geriatric Psychiatry, 21 Bloomingdale Road, White Plains, NY 10605, USA
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Woolf C, Lampit A, Shahnawaz Z, Sabates J, Norrie LM, Burke D, Naismith SL, Mowszowski L. A Systematic Review and Meta-Analysis of Cognitive Training in Adults with Major Depressive Disorder. Neuropsychol Rev 2021; 32:419-437. [PMID: 33913064 DOI: 10.1007/s11065-021-09487-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 02/11/2021] [Indexed: 11/24/2022]
Abstract
Major Depressive Disorder (MDD) is common and disabling, and is linked to functional impairment and increased mortality. While current treatments for MDD are moderately effective, ultimately, up to one third of patients do not achieve full remission. Interestingly, while affective symptoms of major depression typically resolve with the depressive episode, cognitive impairment frequently persists, and has been identified as one of the most prominent predictors of illness recurrence. Additionally, MDD is well-recognised as a key risk factor for further cognitive decline and dementia. Yet, available treatments for MDD do not typically address cognitive impairment. Cognitive training, represents a promising and novel therapeutic intervention in this regard. This review systematically identified and evaluated the evidence for cognitive training in adults with MDD. Following PRISMA guidelines, eligible studies were selected according to pre-defined criteria delineating our target population (adults with clinically defined MDD), parameters for cognitive training interventions (computer-or strategy-based, clinician-facilitated), and study design (controlled trials including pre-post cognitive and psychological or functional outcome data). Of 448 studies identified, nine studies met inclusion criteria. These studies were evaluated for methodological quality and risk of bias. Despite heterogeneity, qualitative and meta-analytic synthesis of study findings revealed significant improvements in cognitive and affective outcomes following cognitive training, with moderate pooled effect sizes. Unfortunately, very few studies investigated 'far transfer' to broader domains of everyday functioning. Overall, given the strong evidence for the efficacy and value of cognitive training in this context, cognitive training should be considered as a primary therapeutic intervention in the treatment of MDD.
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Affiliation(s)
- C Woolf
- Older People's Mental Health Service, St Vincent's Hospital, Sydney, Australia. .,Healthy Brain Ageing Program, Brain and Mind Centre, The University of Sydney, Camperdown, NSW, Australia. .,School of Psychology, The University of Sydney, Camperdown, NSW, Australia.
| | - A Lampit
- Academic Unit for Psychiatry of Old Age, Department of Psychiatry, University of Melbourne, Melbourne, Australia.,Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Z Shahnawaz
- Older People's Mental Health Service, St Vincent's Hospital, Sydney, Australia
| | - J Sabates
- Academic Unit for Psychiatry of Old Age, Department of Psychiatry, University of Melbourne, Melbourne, Australia
| | - L M Norrie
- Older People's Mental Health Service, St Vincent's Hospital, Sydney, Australia.,School of Psychiatry, University of New South Wales, Randwick, Australia
| | - D Burke
- Older People's Mental Health Service, St Vincent's Hospital, Sydney, Australia.,Discipline of Psychiatry, University of Notre Dame, Sydney, Australia.,Department of Psychiatry, Trinity College, Dublin, Ireland
| | - S L Naismith
- Healthy Brain Ageing Program, Brain and Mind Centre, The University of Sydney, Camperdown, NSW, Australia.,Charles Perkins Centre, The University of Sydney, Camperdown, NSW, Australia
| | - L Mowszowski
- Healthy Brain Ageing Program, Brain and Mind Centre, The University of Sydney, Camperdown, NSW, Australia.,Charles Perkins Centre, The University of Sydney, Camperdown, NSW, Australia
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Legemaat AM, Semkovska M, Brouwer M, Geurtsen GJ, Burger H, Denys D, Bockting CL. Effectiveness of cognitive remediation in depression: a meta-analysis. Psychol Med 2021; 52:1-16. [PMID: 33849674 PMCID: PMC9811271 DOI: 10.1017/s0033291721001100] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 02/16/2021] [Accepted: 03/05/2021] [Indexed: 01/12/2023]
Abstract
BACKGROUND Preliminary evidence suggests beneficial effects of cognitive remediation in depression. An update of the current evidence is needed. The aim was to systematically assess the effectiveness of cognitive remediation in depression on three outcomes. METHODS The meta-analysis was pre-registered on PROSPERO (CRD42019124316). PubMed, PsycINFO, Embase and Cochrane Library were searched on 2 February 2019 and 8 November 2020 for peer-reviewed published articles. We included randomized and non-randomized clinical trials comparing cognitive remediation to control conditions in adults with primary depression. Random-effects models were used to calculate Hedges' g, and moderators were assessed using mixed-effects subgroup analyses and meta-regression. Main outcome categories were post-treatment depressive symptomatology (DS), cognitive functioning (CF) and daily functioning (DF). RESULTS We identified 5221 records and included 21 studies reporting on 24 comparisons, with 438 depressed patients receiving cognitive remediation and 540 patients in a control condition. We found a small effect on DS (g = 0.28, 95% CI 0.09-0.46, I2 40%), a medium effect on CF (g = 0.60, 95% CI 0.37-0.83, I2 44%) and a small effect on DF (g = 0.22, 95% CI 0.06-0.39, I2 3%). There were no significant effects at follow-up. Confounding bias analyses indicated possible overestimation of the DS and DF effects in the original studies. CONCLUSIONS Cognitive remediation in depression improves CF in the short term. The effects on DS and DF may have been overestimated. Baseline depressive symptom severity should be considered when administering cognitive remediation.
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Affiliation(s)
- Amanda M. Legemaat
- Department of Psychiatry, Amsterdam University Medical Centers, Academic Medical Center, University of Amsterdam, Amsterdam Neuroscience & Amsterdam Public Health, Meibergdreef 9 1105 AZ, Amsterdam, The Netherlands
| | - Maria Semkovska
- Department of Psychology, University of Southern Denmark, Campusvej 55 DK-5230 Odense M, Denmark
| | - Marlies Brouwer
- Department of Psychiatry, Amsterdam University Medical Centers, Academic Medical Center, University of Amsterdam, Amsterdam Neuroscience & Amsterdam Public Health, Meibergdreef 9 1105 AZ, Amsterdam, The Netherlands
| | - Gert J. Geurtsen
- Department of Medical Psychology, Amsterdam University Medical Centers, Academic Medical Center, University of Amsterdam, Amsterdam Neuroscience & Amsterdam Public Health, Meibergdreef 9 1105 AZ, Amsterdam, The Netherlands
| | - Huibert Burger
- Department of General Practice and Elderly Care Medicine, University Medical Center Groningen, University of Groningen, Antonius Deusinglaan 1 9713 AV, Groningen, The Netherlands
| | - Damiaan Denys
- Department of Psychiatry, Amsterdam University Medical Centers, Academic Medical Center, University of Amsterdam, Amsterdam Neuroscience & Amsterdam Public Health, Meibergdreef 9 1105 AZ, Amsterdam, The Netherlands
| | - Claudi L. Bockting
- Department of Psychiatry, Amsterdam University Medical Centers, Academic Medical Center, University of Amsterdam, Amsterdam Neuroscience & Amsterdam Public Health, Meibergdreef 9 1105 AZ, Amsterdam, The Netherlands
- Centre for Urban Mental Health, University of Amsterdam, Oude Turfmarkt 147 1012 GC, Amsterdam, The Netherlands
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Computerized Cognitive Training: A Review of Mechanisms, Methodological Considerations, and Application to Research in Depression. JOURNAL OF COGNITIVE ENHANCEMENT 2021. [DOI: 10.1007/s41465-021-00209-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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29
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Banerjee D, Mukhopadhyay S. The complex conundrum of geriatric depression and dementias: Revisiting the clinical ambiguity. JOURNAL OF GERIATRIC MENTAL HEALTH 2021. [DOI: 10.4103/jgmh.jgmh_21_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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30
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Hagen BI, Landrø NI, Lau B, Koster EHW, Stubberud J. Predictors of Long-Term Improvement Following Cognitive Remediation in a Sample With Elevated Depressive Symptoms. Front Psychol 2020; 11:2232. [PMID: 33013583 PMCID: PMC7516280 DOI: 10.3389/fpsyg.2020.02232] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 08/10/2020] [Indexed: 11/13/2022] Open
Abstract
Objective Cognitive remediation (CR) techniques (interventions to enhance cognitive functioning) have proven moderately effective in improving cognition and daily functioning in major depressive disorder (MDD). However, baseline predictors of treatment response are lacking. The present study aimed to identify factors influencing long-term CR outcomes in a sample with current or previous, mild or moderate MDD and with self-reported cognitive deficits. Methods Forty-two completers of group-based CR (strategy learning or drill-and-practice), were pooled into one sample. Based on change scores from baseline to 6-month follow-up, participants were categorized as “improvers” or “non-improvers” using reliable change index calculations. Measures included a questionnaire of everyday executive functioning and a neuropsychological test of attention. Finally, improvers and non-improvers were compared in terms of various sociodemographic, psychological, illness-related, and neuropsychological baseline variables. Results Seventeen participants improved reliably in everyday executive functioning, and fourteen demonstrated a reliable improvement in attention. No statistically significant differences emerged between improvers and non-improvers. Conclusion No major predictors of CR were identified. Importantly, the current findings are insufficient to guide clinical decision-making. Large-scale studies with a priori hypotheses are needed to make advances in the future.
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Affiliation(s)
| | | | - Bjørn Lau
- Department of Psychology, University of Oslo, Oslo, Norway
| | - Ernst H W Koster
- Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - Jan Stubberud
- Department of Research, Lovisenberg Diaconal Hospital, Oslo, Norway.,Department of Psychology, University of Oslo, Oslo, Norway
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31
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Hagen BI, Lau B, Joormann J, Småstuen MC, Landrø NI, Stubberud J. Goal management training as a cognitive remediation intervention in depression: A randomized controlled trial. J Affect Disord 2020; 275:268-277. [PMID: 32734919 DOI: 10.1016/j.jad.2020.07.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 06/18/2020] [Accepted: 07/05/2020] [Indexed: 01/25/2023]
Abstract
BACKGROUND Major depressive disorder (MDD) is associated with deficits in executive functioning (EF) that may have a detrimental effect on everyday functioning. Despite this, there are no established cognitive remediation interventions available targeting EF in MDD. Hence, the primary aim of the present pre-registered randomized controlled trial was to evaluate the effectiveness of Goal Management Training (GMT), a metacognitive and strategy-based cognitive remediation intervention to improve EF in MDD. METHODS Sixty-three participants with current or previous mild or moderate MDD and self-reported executive deficits were included and randomized to nine sessions of either GMT (two hours, once weekly; n = 35) or computerized cognitive training (one hour, twice weekly; n = 28). Assessments were conducted at baseline (T1), immediately following training (T2), and at six-month follow-up (T3). The primary outcome measure was The Behavior Rating Inventory of Executive Function - Adult version, pertained to daily life EF. Secondary outcome measures included additional EF assessments (performance-based measures and questionnaires), and depressive symptom severity. RESULTS Forty-three participants completed treatment. Both groups improved following training, and linear mixed model analyses revealed no statistically significant differences between the groups for any outcome measure. Additional exploratory within-group analyses revealed a statistically significant reduction of everyday executive dysfunction and reduced depressive symptoms at the six-month follow-up in GMT only. LIMITATIONS The study was single-blind, and the sample size was modest. CONCLUSIONS Our findings indicate comparable improvements in everyday and performance-based measures of EF, in addition to reductions in depressive symptoms following both GMT and CCT.
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Affiliation(s)
| | - Bjørn Lau
- Department of Psychology, University of Oslo, Norway
| | - Jutta Joormann
- Department of Psychology, Yale University, United States
| | - Milada Cvancarova Småstuen
- Department of Research, Lovisenberg Diaconal Hospital, Norway; Faculty of Health Science, Oslo Metropolitan University, Norway
| | | | - Jan Stubberud
- Department of Research, Lovisenberg Diaconal Hospital, Norway; Department of Psychology, University of Oslo, Norway
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32
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Pimontel MA, Kanellopoulos D, Gunning FM. Neuroanatomical Abnormalities in Older Depressed Adults With Apathy: A Systematic Review. J Geriatr Psychiatry Neurol 2020; 33:289-303. [PMID: 31635522 DOI: 10.1177/0891988719882100] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Apathy is a common phenomenon in late-life depression and is associated with poor outcomes. Apathy is often unrecognized in older depressed adults, and efficacious treatment options are lacking. This review provides a systematic review of the neuroanatomical abnormalities associated with apathy in late-life depression. In addition, the review summarizes the neuroimaging findings from studies of neurodegenerative and focal brain injury conditions that frequently present with apathy. The goal is to elucidate cerebral network abnormalities that give rise to apathy in older adults with mood disturbances and to inform future treatment targets. METHOD Systematic literature review. RESULTS The few studies that have directly examined the neuroanatomical abnormalities of apathy in late-life depression suggest disturbances in the anterior cingulate cortex, insula, orbital and dorsal prefrontal cortex, striatum, and limbic structures (ie, amygdala, thalamus, and hippocampus). Studies examining the neuroanatomical correlates of apathy in other aging populations are consistent with the pattern observed in late-life depression. CONCLUSIONS Apathy in late-life depression appears to be accompanied by neuroanatomical abnormalities in the salience and reward networks. These network findings are consistent with that observed in individuals presenting with apathy in other aging-related conditions. These findings may inform future treatments that target apathy.
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Affiliation(s)
- Monique A Pimontel
- Graduate Center, City University of New York, New York, NY, USA.,Department of Psychiatry, Weill Cornell Medicine, New York, NY, USA
| | | | - Faith M Gunning
- Department of Psychiatry, Weill Cornell Medicine, New York, NY, USA
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33
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Targeting Cognitive Control Deficits With Neuroplasticity-Based Computerized Cognitive Remediation in Patients With Geriatric Major Depression: A Randomized, Double-Blind, Controlled Trial. Am J Geriatr Psychiatry 2020; 28:971-980. [PMID: 32591170 DOI: 10.1016/j.jagp.2020.05.023] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 05/20/2020] [Accepted: 05/20/2020] [Indexed: 11/23/2022]
Abstract
Late life major depression (LLD) is often accompanied by cognitive deficits. When patients have specific deficits in cognitive control functions (CCD), they are not only distressing and debilitating, they often predict poor clinical outcomes such as reduced response to SSRI/SNRI antidepressants, increased disability, suicide and all-cause mortality. We recently reported that in an open label trial, our treatment designed to target these specific CCD with neuroplasticity-based computerized cognitive remediation (nCCR) improved depression and CCD in patients who failed to remit with conventional antidepressant treatment. This study tested the hypothesis that in patients with LLD who have failed at least one trial of an SSRI/SNRI antidepressant at an adequate dose for at least 8 weeks, nCCR will improve both depressive symptoms and the CCD associated with poor antidepressant response (i.e. semantic strategy, inhibition of prepotent responses) more than an active control group. Participants were randomized (1:1) to receive either 30 hours/ 4 weeks of neuroplasticity based computerized cognitive remediation (nCCR) designed to target CCD, or the active control condition matched for duration, engagement, reward, computer presentation, and contact with study staff. All participants and raters were blinded. Mixed effects model analysis the time effect (week) (F(1,71.22)=25.2, p<0.0001) and treatment group X time interaction (F(1,61.8)=11.37, p=.002) reached significance indicating that the slope of decline in MADRS was steeper in the nCCR-GD group. Further, the nCCR group improved their semantic clustering strategy(t(28)=9.5; p=.006), as well as performance on the Stroop interference condition, and cognitive flexibility (Trails B). Further, results transferred to memory performance, which was not a function trained by nCCR. clinicaltrials.gov.
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34
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Brouwer J, van den Berg F, Knooihuizen R, Loerts H, Keijzer M. Exploring Language Learning as a Potential Tool against Cognitive Impairment in Late-Life Depression: Two Meta-Analyses and Suggestions for Future Research. Behav Sci (Basel) 2020; 10:E132. [PMID: 32878051 PMCID: PMC7551097 DOI: 10.3390/bs10090132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 08/25/2020] [Accepted: 08/26/2020] [Indexed: 11/16/2022] Open
Abstract
Late-life depression (LLD) affects about an eighth of community-dwelling seniors. LLD impacts well-being, with loneliness and small social networks being typical. It has also been linked to cognitive dysfunction and an increased risk of developing dementia. Safety and efficacy of pharmacological treatments for LLD have been debated, and cognitive dysfunction often persists even after remission. Various cognitive interventions have been proposed for LLD. Among these, one has received special attention: foreign language learning could serve as a social intervention that simultaneously targets brain structures affected in LLD. Lifelong bilingualism may significantly delay the onset of cognitive impairment symptoms by boosting cognitive reserve. Even late-life foreign language learning without lifelong bilingualism can train cognitive flexibility. It is then counterintuitive that the effects of language learning on LLD have never been examined. In order to create a theoretical basis for further interdisciplinary research, this paper presents a status quo of current work through two meta-analyses investigating cognitive functioning in LLD on the one hand and in senior bilinguals or seniors following a language course on the other hand. While LLD was consistently associated with cognitive dysfunction, inconsistent results were found for bilingualism and language learners. Possible reasons for this and suggestions for future research are subsequently discussed.
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Affiliation(s)
- Jelle Brouwer
- Department of Linguistics & English as a Second Language, University of Groningen, 9712 EK Groningen, The Netherlands; (F.v.d.B.); (R.K.); (M.K.)
| | - Floor van den Berg
- Department of Linguistics & English as a Second Language, University of Groningen, 9712 EK Groningen, The Netherlands; (F.v.d.B.); (R.K.); (M.K.)
| | - Remco Knooihuizen
- Department of Linguistics & English as a Second Language, University of Groningen, 9712 EK Groningen, The Netherlands; (F.v.d.B.); (R.K.); (M.K.)
| | - Hanneke Loerts
- Department of Minorities and Multilingualism, University of Groningen, 9712 EK Groningen, The Netherlands;
| | - Merel Keijzer
- Department of Linguistics & English as a Second Language, University of Groningen, 9712 EK Groningen, The Netherlands; (F.v.d.B.); (R.K.); (M.K.)
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Douglas KM, Milanovic M, Porter RJ, Bowie CR. Clinical and methodological considerations for psychological treatment of cognitive impairment in major depressive disorder. BJPsych Open 2020; 6:e67. [PMID: 32594951 PMCID: PMC7345587 DOI: 10.1192/bjo.2020.53] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Cognitive impairment is considered a core feature of major depressive disorder (MDD) and research into psychological treatments aiming to address cognitive impairment are gaining momentum. Compared with the well-established research base of cognitive treatment trials in schizophrenia, including meta-analyses, mood disorder research is much more preliminary. AIMS To focus on identifying the important factors to consider in developing larger-scale psychological treatment trials targeting cognitive impairment in mood disorders. Trial design recommendations have been published for cognitive treatment trials in bipolar disorder. METHOD An in-depth discussion of methodological considerations in the development of cognitive treatment trials for MDD. RESULTS Methodological considerations include: screening for, and defining, cognitive impairment; mood state when cognitive intervention begins; medication monitoring during cognitive interventions; use of concomitant therapy; level of therapist involvement; duration and dose of treatment; choice of specific cognitive training exercises; home practice; improving adherence; appropriate comparison therapies in clinical trials; and choice of primary outcomes. CONCLUSIONS As well as guidance for clinical trial development, this review may be helpful for clinicians wanting to provide cognitive interventions for individuals with MDD.
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Affiliation(s)
- Katie M Douglas
- Department of Psychological Medicine, University of Otago, New Zealand
| | | | - Richard J Porter
- Department of Psychological Medicine, University of Otago; and Specialist Mental Health Services, Canterbury District Health Board, Christchurch, New Zealand
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Rabipour S, Morrison C, Crompton J, Petrucelli M, de Oliveira Gonçalves Germano M, Popescu A, Davidson PSR. Few Effects of a 5-Week Adaptive Computerized Cognitive Training Program in Healthy Older Adults. JOURNAL OF COGNITIVE ENHANCEMENT 2019. [DOI: 10.1007/s41465-019-00147-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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37
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Manning K, Wang L, Steffens D. Recent advances in the use of imaging in psychiatry: functional magnetic resonance imaging of large-scale brain networks in late-life depression. F1000Res 2019; 8:F1000 Faculty Rev-1366. [PMID: 31448089 PMCID: PMC6685449 DOI: 10.12688/f1000research.17399.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/02/2019] [Indexed: 11/20/2022] Open
Abstract
Advances in neuroimaging have identified neural systems that contribute to clinical symptoms that occur across various psychiatric disorders. This transdiagnostic approach to understanding psychiatric illnesses may serve as a precise guide to identifying disease mechanisms and informing successful treatments. While this work is ongoing across multiple psychiatric disorders, in this article we emphasize recent findings pertaining to major depression in the elderly, or late-life depression (LLD), a common and debilitating neuropsychiatric illness. We discuss how neural functioning of three networks is linked to symptom presentation, illness course, and cognitive decline in LLD. These networks are (1) an executive control network responsible for complex cognitive processing, (2) a default mode network normally deactivated during cognitive demanding when individuals are at rest, and a (3) salience network relevant to attending to internal and external emotional and physiological sensations. We discuss how dysfunction in multiple networks contributes to common behavioral syndromes, and we present an overview of the cognitive control, default mode, and salience networks observed in LLD.
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Affiliation(s)
- Kevin Manning
- Department of Psychiatry, University of Connecticut Health Center, Farmington, CT, USA
| | - Lihong Wang
- Department of Psychiatry, University of Connecticut Health Center, Farmington, CT, USA
| | - David Steffens
- Department of Psychiatry, University of Connecticut Health Center, Farmington, CT, USA
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Alexopoulos GS. Mechanisms and treatment of late-life depression. Transl Psychiatry 2019; 9:188. [PMID: 31383842 PMCID: PMC6683149 DOI: 10.1038/s41398-019-0514-6] [Citation(s) in RCA: 261] [Impact Index Per Article: 52.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 11/26/2018] [Accepted: 01/01/2019] [Indexed: 01/25/2023] Open
Abstract
Depression predisposes to medical illnesses and advances biological aging indicated by shorter telomere length, accelerated brain aging and advanced epigenetic aging. Medical illnesses also increase the risk of late-life depression. The reciprocal relationships of depression with aging-related and disease-related processes have generated pathogenetic hypotheses and provided treatment targets. Targeting risk factors of vascular disease in mid-life is a logical approach in prevention of vascular depression. The depression-executive dysfunction and the vascular depression syndromes have clinical presentations and neuroimaging findings consistent with frontostriatal abnormalities. Dopamine D2/3 agonists are effective in depression of Parkinson's disease and their efficacy needs to be assessed in these two syndromes. Computerized cognitive remediation targeting functions of the cognitive control network may improve both executive functions and depressive symptoms of late-life major depression. Significant progress has been made in neurostimulation treatments in depressed younger adults. TMS targeting deep structures responsible for mood regulation is well tolerated by older adults and its efficacy in syndromes of late-life depression needs to be studied. Efficacious psychotherapies for late-life depression exist, but are underutilized in part because of their complexity. Streamlined, stepped psychotherapies targeting behaviors assumed to result from dysfunction of brain networks implicated in late-life depression can be easy to learn and have potential for dissemination. However, their effectiveness needs further investigation. Depression increases the risk of dementing disorders. Antidepressants are rather ineffective in treating depression of demented patients, but long-term use of antidepressants may reduce the risk of dementia. However, confirmation studies are needed.
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Affiliation(s)
- George S. Alexopoulos
- 000000041936877Xgrid.5386.8Weill Cornell Institute of Geriatric Psychiatry, 21 Bloomingdale Road, White Plains, NY 10605 USA
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Lissemore JI, Shanks HRC, Butters MA, Bhandari A, Zomorrodi R, Rajji TK, Karp JF, Reynolds CF, Lenze EJ, Daskalakis ZJ, Mulsant BH, Blumberger DM. An inverse relationship between cortical plasticity and cognitive inhibition in late-life depression. Neuropsychopharmacology 2019; 44:1659-1666. [PMID: 31071718 PMCID: PMC6785107 DOI: 10.1038/s41386-019-0413-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 04/27/2019] [Accepted: 05/01/2019] [Indexed: 11/08/2022]
Abstract
Executive dysfunction is a common and disabling component of late-life depression (LLD), yet its neural mechanisms remain unclear. In particular, it is not yet known how executive functioning in LLD relates to measures of cortical physiology that may change with age and illness, namely cortical inhibition/excitation and plasticity. Here, we used transcranial magnetic stimulation (TMS) to measure cortical inhibition/excitation (n = 51), and the potentiation of cortical activity following paired associative stimulation, which is thought to reflect long-term potentiation (LTP)-like cortical plasticity (n = 32). We assessed the correlation between these measures of cortical physiology and two measures of executive functioning: cognitive inhibition, assessed using the Delis-Kaplan Executive Function System Color-Word Interference ["Stroop"] Test, and cognitive flexibility, assessed using the Trail Making Test. Correlations with recall memory and processing speed were also performed to assess the specificity of any associations to executive functioning. A significant correlation was found between greater LTP-like cortical plasticity and poorer cognitive inhibition, a core executive function (rp = -0.56, p < 0.001). We did not observe significant associations between cortical inhibition/excitation and executive functioning, or between any neurophysiological measure and cognitive flexibility, memory, or processing speed. Our finding that elevated cortical plasticity is associated with diminished cognitive inhibition emphasizes the importance of balanced synaptic strengthening to healthy cognition. More specifically, our findings suggest that hyper-excitability of cortical circuits following repeated cortical activation may promote inappropriate prepotent responses in LLD. LTP-like cortical plasticity might therefore represent a neural mechanism underlying an inhibitory control cognitive endophenotype of LLD.
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Affiliation(s)
- Jennifer I Lissemore
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, M6J 1H4, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, M5T 1R8, Canada
| | - Hayley R C Shanks
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, M6J 1H4, Canada
| | - Meryl A Butters
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Apoorva Bhandari
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, M6J 1H4, Canada
| | - Reza Zomorrodi
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, M6J 1H4, Canada
| | - Tarek K Rajji
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, M6J 1H4, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, M5T 1R8, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, M5T 1R8, Canada
| | - Jordan F Karp
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- VAPHS, Geriatric Research Education and Clinical Center, Pittsburgh, PA, USA
| | - Charles F Reynolds
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Eric J Lenze
- Healthy Mind Lab, Department of Psychiatry, Washington University School of Medicine, St Louis, MO, USA
| | - Zafiris J Daskalakis
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, M6J 1H4, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, M5T 1R8, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, M5T 1R8, Canada
| | - Benoit H Mulsant
- Department of Psychiatry, University of Toronto, Toronto, ON, M5T 1R8, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, M5T 1R8, Canada
| | - Daniel M Blumberger
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, M6J 1H4, Canada.
- Department of Psychiatry, University of Toronto, Toronto, ON, M5T 1R8, Canada.
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, M5T 1R8, Canada.
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Alexopoulos GS. Promoting Health Behaviors For Aging Persons. Am J Geriatr Psychiatry 2019; 27:237-240. [PMID: 30679021 DOI: 10.1016/j.jagp.2018.12.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 12/18/2018] [Indexed: 11/24/2022]
Affiliation(s)
- George S Alexopoulos
- Department of Psychiatry (GSA), Weill Cornell Medical College, White Plains, NY.
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Chen ST, Volle D, Jalil J, Wu P, Small GW. Health-Promoting Strategies for the Aging Brain. Am J Geriatr Psychiatry 2019; 27:213-236. [PMID: 30686664 DOI: 10.1016/j.jagp.2018.12.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 12/11/2018] [Accepted: 12/11/2018] [Indexed: 12/31/2022]
Abstract
As the world's population ages and people live longer, the changes in the aging brain present substantial challenges to our health and society. With greater longevity come age-related diseases, many of which have direct and indirect influences on the health of the brain. Although there is some degree of predictable decline in brain functioning with aging, meaningful cognitive decline is not inevitable and is perhaps preventable. In this review, we present the case that the course of aging-related brain disease and dysfunction can be modified. We present the evidence for conditions and risk factors that may contribute to cognitive decline and dementia and for interventions that may mitigate their impact on cognitive functioning later in life, or even prevent them and their cognitive sequelae from developing. Although much work remains to be done to meet the challenges of the aging brain, strategies to promote its health have been demonstrated and offer much promise, which can only be realized if we mount a vigorous public health effort to implement these strategies.
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Affiliation(s)
- Stephen T Chen
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles; the University of California, Los Angeles, Longevity Center, Los Angeles; David Geffen School of Medicine, University of California, Los Angeles, Los Angeles.
| | - Dax Volle
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles; the University of California, Los Angeles, Longevity Center, Los Angeles; David Geffen School of Medicine, University of California, Los Angeles, Los Angeles
| | - Jason Jalil
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles; the University of California, Los Angeles, Longevity Center, Los Angeles; David Geffen School of Medicine, University of California, Los Angeles, Los Angeles
| | - Pauline Wu
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles; the University of California, Los Angeles, Longevity Center, Los Angeles; David Geffen School of Medicine, University of California, Los Angeles, Los Angeles
| | - Gary W Small
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles; the University of California, Los Angeles, Longevity Center, Los Angeles; David Geffen School of Medicine, University of California, Los Angeles, Los Angeles
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Ng CH, Kato T, Han C, Wang G, Trivedi M, Ramesh V, Shao D, Gala S, Narayanan S, Tan W, Feng Y, Kasper S. Definition of treatment-resistant depression - Asia Pacific perspectives. J Affect Disord 2019; 245:626-636. [PMID: 30445388 DOI: 10.1016/j.jad.2018.11.038] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 09/07/2018] [Accepted: 11/03/2018] [Indexed: 01/25/2023]
Abstract
BACKGROUND The lack of uniformity in the definition of treatment resistant depression (TRD) within the Asia-Pacific (APAC) region may have implications for patient management. We aimed to characterize the most commonly used TRD definition in selected APAC countries. METHODS A systematic literature review of TRD definitions in APAC countries was conducted in Medline and Embase (2010-2016) and conference proceedings (2014 and 2016). TRD guidelines (APAC, Europe regional, US, or international) were also searched. An expert-panel explored APAC nuances in TRD definitions to achieve consensus for a regional-level definition. RESULTS Ten guidelines and 89 studies qualified for study inclusion. Among the studies, variations were observed in definitions regarding: number of antidepressants failed (range: ≥1 to ≥3), classes of antidepressants (same or different; 59% did not specify class), duration of previous treatments (range: 4-12 weeks), dosage adequacy, and consideration of adherence (yes/no; 88% of studies did not consider adherence). No TRD-specific guidelines were identified. The emerging consensus from the literature review and panel discussion was that TRD is most commonly defined as failure to ≥2 antidepressant therapies given at adequate doses, for 6-8 weeks during a major depressive episode. LIMITATIONS Few studies provided definitions of TRD used in daily clinical practice, and a limited number of countries were represented in the included studies and expert panel. CONCLUSION Attaining consensus on TRD definition may promote accurate, and possibly early detection of patients with TRD to enable appropriate intervention that may impact patient outcomes and quality of life.
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Affiliation(s)
- C H Ng
- Department of Psychiatry, University of Melbourne, Victoria, Australia
| | - T Kato
- RIKEN Brain Science Institute, Saitama, Japan
| | - C Han
- Korea University, Seoul, South Korea
| | - G Wang
- Capital Medical University, Anding Hospital, Beijing, China
| | - M Trivedi
- University of Texas Southwestern Medical Center, TX, US
| | - V Ramesh
- Market Access Solutions, LLC, USA
| | - D Shao
- Market Access Solutions, LLC, USA
| | - S Gala
- Market Access Solutions, LLC, USA
| | | | - W Tan
- Janssen Asia Pacific, Singapore
| | - Y Feng
- Janssen Asia Pacific, Singapore
| | - S Kasper
- Medical University of Vienna, Vienna, Austria
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Caraci F, Calabrese F, Molteni R, Bartova L, Dold M, Leggio GM, Fabbri C, Mendlewicz J, Racagni G, Kasper S, Riva MA, Drago F. International Union of Basic and Clinical Pharmacology CIV: The Neurobiology of Treatment-resistant Depression: From Antidepressant Classifications to Novel Pharmacological Targets. Pharmacol Rev 2018; 70:475-504. [PMID: 29884653 DOI: 10.1124/pr.117.014977] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Major depressive disorder is one of the most prevalent and life-threatening forms of mental illnesses and a major cause of morbidity worldwide. Currently available antidepressants are effective for most patients, although around 30% are considered treatment resistant (TRD), a condition that is associated with a significant impairment of cognitive function and poor quality of life. In this respect, the identification of the molecular mechanisms contributing to TRD represents an essential step for the design of novel and more efficacious drugs able to modify the clinical course of this disorder and increase remission rates in clinical practice. New insights into the neurobiology of TRD have shed light on the role of a number of different mechanisms, including the glutamatergic system, immune/inflammatory systems, neurotrophin function, and epigenetics. Advances in drug discovery processes in TRD have also influenced the classification of antidepressant drugs and novel classifications are available, such as the neuroscience-based nomenclature that can incorporate such advances in drug development for TRD. This review aims to provide an up-to-date description of key mechanisms in TRD and describe current therapeutic strategies for TRD before examining novel approaches that may ultimately address important neurobiological mechanisms not targeted by currently available antidepressants. All in all, we suggest that drug targeting different neurobiological systems should be able to restore normal function but must also promote resilience to reduce the long-term vulnerability to recurrent depressive episodes.
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Affiliation(s)
- F Caraci
- Departments of Drug Sciences (F.Car.) and Biomedical and Biotechnological Sciences, School of Medicine (G.M.L., F.D.), University of Catania, Catania, Italy; Oasi-Research-Institute-IRCCS, Troina, Italy (F.Car.); Departments of Pharmacological and Biomolecular Sciences (F.Cal., G.R., M.A.R.) and Medical Biotechnology and Translational Medicine (R.M.), Università degli Studi di Milano, Milan, Italy; Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria (L.B., M.D., S.K.); Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy (C.F.); and School of Medicine, Universite' Libre de Bruxelles, Bruxelles, Belgium (J.M.)
| | - F Calabrese
- Departments of Drug Sciences (F.Car.) and Biomedical and Biotechnological Sciences, School of Medicine (G.M.L., F.D.), University of Catania, Catania, Italy; Oasi-Research-Institute-IRCCS, Troina, Italy (F.Car.); Departments of Pharmacological and Biomolecular Sciences (F.Cal., G.R., M.A.R.) and Medical Biotechnology and Translational Medicine (R.M.), Università degli Studi di Milano, Milan, Italy; Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria (L.B., M.D., S.K.); Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy (C.F.); and School of Medicine, Universite' Libre de Bruxelles, Bruxelles, Belgium (J.M.)
| | - R Molteni
- Departments of Drug Sciences (F.Car.) and Biomedical and Biotechnological Sciences, School of Medicine (G.M.L., F.D.), University of Catania, Catania, Italy; Oasi-Research-Institute-IRCCS, Troina, Italy (F.Car.); Departments of Pharmacological and Biomolecular Sciences (F.Cal., G.R., M.A.R.) and Medical Biotechnology and Translational Medicine (R.M.), Università degli Studi di Milano, Milan, Italy; Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria (L.B., M.D., S.K.); Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy (C.F.); and School of Medicine, Universite' Libre de Bruxelles, Bruxelles, Belgium (J.M.)
| | - L Bartova
- Departments of Drug Sciences (F.Car.) and Biomedical and Biotechnological Sciences, School of Medicine (G.M.L., F.D.), University of Catania, Catania, Italy; Oasi-Research-Institute-IRCCS, Troina, Italy (F.Car.); Departments of Pharmacological and Biomolecular Sciences (F.Cal., G.R., M.A.R.) and Medical Biotechnology and Translational Medicine (R.M.), Università degli Studi di Milano, Milan, Italy; Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria (L.B., M.D., S.K.); Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy (C.F.); and School of Medicine, Universite' Libre de Bruxelles, Bruxelles, Belgium (J.M.)
| | - M Dold
- Departments of Drug Sciences (F.Car.) and Biomedical and Biotechnological Sciences, School of Medicine (G.M.L., F.D.), University of Catania, Catania, Italy; Oasi-Research-Institute-IRCCS, Troina, Italy (F.Car.); Departments of Pharmacological and Biomolecular Sciences (F.Cal., G.R., M.A.R.) and Medical Biotechnology and Translational Medicine (R.M.), Università degli Studi di Milano, Milan, Italy; Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria (L.B., M.D., S.K.); Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy (C.F.); and School of Medicine, Universite' Libre de Bruxelles, Bruxelles, Belgium (J.M.)
| | - G M Leggio
- Departments of Drug Sciences (F.Car.) and Biomedical and Biotechnological Sciences, School of Medicine (G.M.L., F.D.), University of Catania, Catania, Italy; Oasi-Research-Institute-IRCCS, Troina, Italy (F.Car.); Departments of Pharmacological and Biomolecular Sciences (F.Cal., G.R., M.A.R.) and Medical Biotechnology and Translational Medicine (R.M.), Università degli Studi di Milano, Milan, Italy; Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria (L.B., M.D., S.K.); Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy (C.F.); and School of Medicine, Universite' Libre de Bruxelles, Bruxelles, Belgium (J.M.)
| | - C Fabbri
- Departments of Drug Sciences (F.Car.) and Biomedical and Biotechnological Sciences, School of Medicine (G.M.L., F.D.), University of Catania, Catania, Italy; Oasi-Research-Institute-IRCCS, Troina, Italy (F.Car.); Departments of Pharmacological and Biomolecular Sciences (F.Cal., G.R., M.A.R.) and Medical Biotechnology and Translational Medicine (R.M.), Università degli Studi di Milano, Milan, Italy; Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria (L.B., M.D., S.K.); Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy (C.F.); and School of Medicine, Universite' Libre de Bruxelles, Bruxelles, Belgium (J.M.)
| | - J Mendlewicz
- Departments of Drug Sciences (F.Car.) and Biomedical and Biotechnological Sciences, School of Medicine (G.M.L., F.D.), University of Catania, Catania, Italy; Oasi-Research-Institute-IRCCS, Troina, Italy (F.Car.); Departments of Pharmacological and Biomolecular Sciences (F.Cal., G.R., M.A.R.) and Medical Biotechnology and Translational Medicine (R.M.), Università degli Studi di Milano, Milan, Italy; Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria (L.B., M.D., S.K.); Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy (C.F.); and School of Medicine, Universite' Libre de Bruxelles, Bruxelles, Belgium (J.M.)
| | - G Racagni
- Departments of Drug Sciences (F.Car.) and Biomedical and Biotechnological Sciences, School of Medicine (G.M.L., F.D.), University of Catania, Catania, Italy; Oasi-Research-Institute-IRCCS, Troina, Italy (F.Car.); Departments of Pharmacological and Biomolecular Sciences (F.Cal., G.R., M.A.R.) and Medical Biotechnology and Translational Medicine (R.M.), Università degli Studi di Milano, Milan, Italy; Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria (L.B., M.D., S.K.); Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy (C.F.); and School of Medicine, Universite' Libre de Bruxelles, Bruxelles, Belgium (J.M.)
| | - S Kasper
- Departments of Drug Sciences (F.Car.) and Biomedical and Biotechnological Sciences, School of Medicine (G.M.L., F.D.), University of Catania, Catania, Italy; Oasi-Research-Institute-IRCCS, Troina, Italy (F.Car.); Departments of Pharmacological and Biomolecular Sciences (F.Cal., G.R., M.A.R.) and Medical Biotechnology and Translational Medicine (R.M.), Università degli Studi di Milano, Milan, Italy; Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria (L.B., M.D., S.K.); Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy (C.F.); and School of Medicine, Universite' Libre de Bruxelles, Bruxelles, Belgium (J.M.)
| | - M A Riva
- Departments of Drug Sciences (F.Car.) and Biomedical and Biotechnological Sciences, School of Medicine (G.M.L., F.D.), University of Catania, Catania, Italy; Oasi-Research-Institute-IRCCS, Troina, Italy (F.Car.); Departments of Pharmacological and Biomolecular Sciences (F.Cal., G.R., M.A.R.) and Medical Biotechnology and Translational Medicine (R.M.), Università degli Studi di Milano, Milan, Italy; Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria (L.B., M.D., S.K.); Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy (C.F.); and School of Medicine, Universite' Libre de Bruxelles, Bruxelles, Belgium (J.M.)
| | - F Drago
- Departments of Drug Sciences (F.Car.) and Biomedical and Biotechnological Sciences, School of Medicine (G.M.L., F.D.), University of Catania, Catania, Italy; Oasi-Research-Institute-IRCCS, Troina, Italy (F.Car.); Departments of Pharmacological and Biomolecular Sciences (F.Cal., G.R., M.A.R.) and Medical Biotechnology and Translational Medicine (R.M.), Università degli Studi di Milano, Milan, Italy; Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria (L.B., M.D., S.K.); Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy (C.F.); and School of Medicine, Universite' Libre de Bruxelles, Bruxelles, Belgium (J.M.)
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Cognitive Functioning in Late-life Depression: A Critical Review of Sociodemographic, Neurobiological, and Treatment Correlates. Curr Behav Neurosci Rep 2018. [DOI: 10.1007/s40473-018-0159-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Laird KT, Lavretsky H, St. Cyr N, Siddarth P. Resilience predicts remission in antidepressant treatment of geriatric depression. Int J Geriatr Psychiatry 2018; 33:1596-1603. [PMID: 30035325 PMCID: PMC6246780 DOI: 10.1002/gps.4953] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 06/17/2018] [Indexed: 11/05/2022]
Abstract
OBJECTIVES With the world population rapidly aging, it is increasingly important to identify sociodemographic, cognitive, and clinical features that predict poor outcome in geriatric depression. Self-report measures of resilience-ie, the ability to adapt and thrive in the face of adversity-may identify those depressed older adults with more favorable prognoses. METHODS We investigated the utility of baseline variables including 4 factors of resilience (grit, active coping self-efficacy, accommodative coping self-efficacy, and spirituality) for predicting treatment response and remission in a 16-week randomized controlled trial of methylphenidate, citalopram, or their combination in 143 adults over the age of 60 with MDD. RESULTS Final logistic regression models revealed that greater total baseline resilience (Wald χ2 = 3.8, P = 0.05) significantly predicted both treatment response and remission. Specifically, a 20% increase in total resilience predicted nearly 2 times greater likelihood of remission (OR = 1.98, 95% CI = [1.01, 3.91]). Examining the individual factors of resilience, only accommodative coping self-efficacy (Wald χ2 = 3.7, P = 0.05; OR = 1.41 [1.00-2.01]) was significantly associated with remission. We found no relation between baseline sociodemographic factors (age, sex, race, education level) or measures of cognitive performance and posttreatment depressive symptoms. CONCLUSIONS Self-reported resilience may predict greater responsivity to antidepressant medication in older adults with MDD. Future research should investigate the potential for resilience training-and in particular, interventions designed to increase accommodative coping-to promote sustained remission of geriatric depression.
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Affiliation(s)
- Kelsey T. Laird
- Department of Psychiatry; Semel Institute for Neuroscience and Human Behavior at UCLA; Los Angeles CA USA
| | - Helen Lavretsky
- Department of Psychiatry; Semel Institute for Neuroscience and Human Behavior at UCLA; Los Angeles CA USA
| | - Natalie St. Cyr
- Department of Psychiatry; Semel Institute for Neuroscience and Human Behavior at UCLA; Los Angeles CA USA
| | - Prabha Siddarth
- Department of Psychiatry; Semel Institute for Neuroscience and Human Behavior at UCLA; Los Angeles CA USA
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46
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Non-Pharmacological Cognitive Remediation Strategies for Treatment of Depression and Cognitive Impairment. Curr Behav Neurosci Rep 2018. [DOI: 10.1007/s40473-018-0158-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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47
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Wojtalik JA, Eack SM, Smith MJ, Keshavan MS. Using Cognitive Neuroscience to Improve Mental Health Treatment: A Comprehensive Review. JOURNAL OF THE SOCIETY FOR SOCIAL WORK AND RESEARCH 2018; 9:223-260. [PMID: 30505392 PMCID: PMC6258037 DOI: 10.1086/697566] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Mental health interventions do not yet offer complete, client-defined functional recovery, and novel directions in treatment research are needed to improve the efficacy of available interventions. One promising direction is the integration of social work and cognitive neuroscience methods, which provides new opportunities for clinical intervention research that will guide development of more effective mental health treatments that holistically attend to the biological, social, and environmental contributors to disability and recovery. This article reviews emerging trends in cognitive neuroscience and provides examples of how these advances can be used by social workers and allied professions to improve mental health treatment. We discuss neuroplasticity, which is the dynamic and malleable nature of the brain. We also review the use of risk and resiliency biomarkers and novel treatment targets based on neuroimaging findings to prevent disability, personalize treatment, and make interventions more targeted and effective. The potential of treatment research to contribute to neuroscience discoveries regarding brain change is considered from the experimental-medicine approach adopted by the National Institute of Mental Health. Finally, we provide resources and recommendations to facilitate the integration of cognitive neuroscience into mental health research in social work.
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Affiliation(s)
- Jessica A Wojtalik
- Doctoral candidate at the University of Pittsburgh School of Social Work
| | - Shaun M Eack
- Professor at the University of Pittsburgh School of Social Work and Department of Psychiatry
| | - Matthew J Smith
- Associate professor at the University of Michigan School of Social Work
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Manning KJ, Steffens DC. State of the Science of Neural Systems in Late-Life Depression: Impact on Clinical Presentation and Treatment Outcome. J Am Geriatr Soc 2018; 66 Suppl 1:S17-S23. [PMID: 29659005 PMCID: PMC5905432 DOI: 10.1111/jgs.15353] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Revised: 01/30/2018] [Accepted: 02/05/2018] [Indexed: 11/29/2022]
Abstract
Major depression in older adults, or late-life depression (LLD), is a common and debilitating psychiatric disorder that increases the risk of morbidity and mortality. Although the effects of LLD make it important to achieve a diagnosis and start treatment quickly, individuals with LLD are often inadequately or unsuccessfully treated. The latest treatment developments suggest that interventions targeting executive dysfunction and neuroticism, constructs associated with poor response to antidepressants in older adults, are successful in treating LLD. Specific behavioral interventions (computerized cognitive training, mindfulness meditation, aerobic exercise) appear to decrease depressive symptoms and ameliorate executive dysfunction and neuroticism, but we do not fully understand the mechanisms by which these treatments work. We review recent research on neural network changes underlying executive dysfunction and neuroticism in LLD and their association with clinical outcomes (e.g., treatment response, cognitive functioning).
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Affiliation(s)
- Kevin J Manning
- Department of Psychiatry, School of Medicine, University of Connecticut, Farmington, Connecticut
| | - David C Steffens
- Department of Psychiatry, School of Medicine, University of Connecticut, Farmington, Connecticut
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Salagre E, Solé B, Tomioka Y, Fernandes BS, Hidalgo-Mazzei D, Garriga M, Jimenez E, Sanchez-Moreno J, Vieta E, Grande I. Treatment of neurocognitive symptoms in unipolar depression: A systematic review and future perspectives. J Affect Disord 2017. [PMID: 28651185 DOI: 10.1016/j.jad.2017.06.034] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Cognitive symptoms in Major Depressive Disorder (MDD) are persistent and commonly entail neurocognitive impairment and a decline in quality of life. This systematic review gathers the current scientific evidence on therapeutic strategies for neuropsychological impairment in MDD. METHOD A systematic search on PubMed, PsycINFO and Clinicaltrials.gov was carried out on December 2016 according to PRISMA using Boolean terms to identify interventions for the treatment of cognitive dysfunction in MDD. Only English-written articles providing original data and focusing in adults with MDD were included with no time restrictions. RESULTS A total of 95 studies reporting data on 40 pharmacological and non-pharmacological interventions were included. Interventions were grouped into the following categories: 1) Pharmacological Therapies (antidepressants, stimulants, compounds acting on NMDA receptors, compounds acting on the cholinergic system, compounds showing anti-inflammatory or antioxidant properties, other mechanisms of action), 2) Physical Therapies and 3) Psychological Therapies, 4) Exercise. There are some promising compounds showing a positive impact on cognitive symptoms including vortioxetine, lisdexamfetamine or erythropoietin. LIMITATIONS The studies included showed significant methodological differences in heterogeneous samples. The lack of a standardized neuropsychological battery makes comparisons between studies difficult. CONCLUSION Current evidence is not sufficient to widely recommend the use of procognitive treatments in MDD although promising results are coming to light.
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Affiliation(s)
- E Salagre
- Bipolar Disorders Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - B Solé
- Bipolar Disorders Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Y Tomioka
- Bipolar Disorders Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - B S Fernandes
- Deakin University, IMPACT Strategic Research Centre, School of Medicine, Barwon Health, Geelong, Australia; Laboratory of Calcium Binding Proteins in the Central Nervous System, Department of Biochemistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - D Hidalgo-Mazzei
- Bipolar Disorders Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - M Garriga
- Bipolar Disorders Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - E Jimenez
- Bipolar Disorders Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - J Sanchez-Moreno
- Bipolar Disorders Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - E Vieta
- Bipolar Disorders Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain.
| | - I Grande
- Bipolar Disorders Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
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Longitudinal Cognitive Outcomes of Clinical Phenotypes of Late-Life Depression. Am J Geriatr Psychiatry 2017; 25:1123-1134. [PMID: 28479153 PMCID: PMC5600662 DOI: 10.1016/j.jagp.2017.03.016] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 11/15/2016] [Accepted: 03/24/2017] [Indexed: 01/24/2023]
Abstract
OBJECTIVE Late-life depression is associated with cognitive deficits and increased risk for cognitive decline. The purpose of the study was to determine whether clinical characteristics could serve as phenotypes informative of subsequent cognitive decline. Age at depression onset and antidepressant remission at 3 months (acute response) and 12 months (chronic response) were examined. METHODS In a longitudinal study of late-life depression in an academic center, 273 depressed and 164 never-depressed community-dwelling elders aged 60 years or older were followed on average for over 5 years. Participants completed annual neuropsychological testing. Neuropsychological measures were converted to z-scores derived from the baseline performance of all participants. Cognitive domain scores at each time were then created by averaging z-scores across tests, grouped into domains of episodic memory, attention-working memory, verbal fluency, and executive function. RESULTS Depressed participants exhibited poorer performance at baseline and greater subsequent decline in all domains. Early-onset depressed individuals exhibited a greater decline in all domains than late-onset or nondepressed groups. For remission, remitters and nonremitters at both 3 and 12 month exhibited greater decline in episodic memory and attention-working memory than nondepressed subjects. Three-month remitters also exhibited a greater decline in verbal fluency and executive function, whereas 12-month nonremitters exhibited greater decline in executive function than other groups. CONCLUSION Consistent with past studies, depressed elders exhibit greater cognitive decline than nondepressed subjects, particularly individuals with early depression onset, supporting the theory that repeated depressive episodes may contribute to decline. Clinical remission is not associated with less cognitive decline.
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